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Sunday, 3 January 2021

Malaysians staying home less despite third wave; Beating Covid-19 in 2021 required managing time, risk and ambition

Report shows more people going out again after Dec 7


Since the start of the conditional movement control order in May, the amount of time Malaysians spent at home has mostly been on a downward trend even as Covid-19 cases soared in the past few months.

This is one of the insights from Oxford University’s Our World in Data portal (ourworldindata.org), which analysed a report from Google that tracks the movement of people in more than 130 countries since the pandemic began.

Google’s Covid- 19 Community Mobility Report records changes in the number of visitors each day to various types of locations such as workplaces, and retail and recreational areas.

The report, based on data Google collects from users who have their location history setting turned on, also measures the change in the amount of time people spend at home each day.

The daily changes are compared with a baseline figure taken from before the pandemic, which is the median value over the five-week period from Jan 3 to Feb 6, 2020.

Charts created by Our World in Data based on the Google report shows how the movement of people, including in Malaysia, changed throughout the pandemic.

When Covid-19 first emerged, many Malaysians were still spending their days mostly at their workplaces or other locations instead of being at home.

That changed after the MCO was introduced on March 18.

On March 27, time spent at home shot up with a 36.14% increase compared with the baseline period while the number of visitors to workplaces fell to negative 63.71% due to MCO restrictions.

Malaysians, however, started venturing out of their homes more following the introduction of the conditional MCO on May 4.

The conditional MCO relaxed some of the earlier restrictions, with most economic sectors and activities allowed to operate with physical distancing.

As a result, time spent at home started falling and on Aug 30 hit a low of just 4.57% more than the baseline.

The start of a third wave of Covid19 cases since Sept 20 saw a relatively brief increase in time spent at home.

However, the figure fell again especially after Dec 7 when restrictions on inter-district and interstate travel were lifted, with the exception of areas under the enhanced MCO

Beating Covid-19 in 2021: Managing time, risk and ambition


Think bigger: We must reimagine a a new social contract for health, one that protects citizens and non-citizens in fair, sustainable and politically acceptable ways. 

 VERY often in the pandemic of 2020, we found ourselves in situations with no good choices. That's normal. This is a once-in-a-lifetime pandemic with no useful policy textbooks or manuals. Public health experts and scientists raced to understand Covid-19, and we continue to learn more. Political leaders and policymakers struggled to deploy old solutions for a vast new problem.

It's now 11 months since Malaysia's first Covid-19 case. As we forge ahead into 2021, I humbly offer three strategies for Malaysia's national health: to use time wisely; to stabilise our tolerance levels of risk; and to match our solutions to the size of the problem. This will help us in our second year with Covid-19.

Firstly, Malaysia must use time wisely. In other words, we must prepare for future problems today, instead of waiting for the problems to arrive. For example, we had four months between June-Sept 2020 when we had very few cases. That quiet period came after a national MCO sacrifice of two months. We may not have utilised that four quiet months effectively.

Some of the problems in the third wave are similar to the problems in the first two waves. Examples include the living conditions of foreign workers, the speed and scale of testing and isolating, effective contact tracing using apps, data sharing from the Health Ministry, and coordination between federal-state responses.

This is why Malaysia must use time wisely in 2021. Quiet periods or not, the government must use time to rebuild, strengthen infrastructure and implement long-term durable solutions. Two specific examples include building the vaccine infrastructure before the first stocks arrive in Feb 2021, and to deliver a clear management plan when we find positive Covid-19 cases during the mass testing of foreign workers starting in Jan 2021.

In the second year of the pandemic, we cannot fight the same problems as in the first year. We must get these old problems under control, and then solve new ones. That means we must use our time wisely, and not waste it.

The second strategy for national health in 2021 is to stabilise our tolerance levels for risk. After one year, it seems like we are willing to tolerate much higher levels of risk, compared to the early stages of the pandemic. This can be dangerous. We must have a stable tolerance level of risk, not increasingly tolerate more and more risk.

Here's an example. In March, we had approximately 100-300 daily new cases. In December, we had approximately 850-2300 daily new cases. Despite this dramatic increase, everyone has started taking Covid-19 lightly. Government entities are no longer marching to the same disciplined tune as in the beginning of the pandemic and appear to be more relaxed. Citizens are no longer consistently wearing masks or physically distancing.

There may be reasons why we take it lightly. We all have pandemic fatigue and want our old lives back. Malaysia may have 2000 daily cases in December, but we feel better when comparing it to Indonesia's 5000-8000 cases or the United Kingdom's 13,000-53,000 cases in the same month. These are understandable, but dangerous.

We cannot take Covid-19 lightly. We cannot endlessly tolerate increasing amounts of pandemic risk. I do not think a second full lockdown will work to help avoid it. But I do not believe that we can endlessly tolerate more risk and assume that we will never need it.

What I do support is a stable level of risk tolerance. In other words, take Covid-19 consistently seriously until we are all safe. A pandemic continues to rage around us. To government agencies, take things seriously, communicate better, use time wisely and prepare for future problems. To citizens, wear your masks and stay home where possible. Don't let the increasing numbers numb us into thinking that we can endlessly tolerate more risk.

The third and final strategy for national health in 2021 is to match our solutions to the size of the pandemic. In other words, we need solutions that are proportional to the size of the problem. After one year of fighting Covid-19, we know that our pre-2020 solutions, tools and policies are inadequate. Covid-19 is simply too big for any old solutions.

In the early stages, all governments are forgiven if they don't know what to do. After one year of Covid-19, all governments lose that excuse. Given the scale of Covid-19, we need ambitious, imaginative and Very Big solutions to a Very Big problem. In other words, unprecedented problems need unprecedented solutions, not old, timid and ineffective solutions.

This means that our government must aim much higher in 2021. We need new ways to deliver history's most important vaccination program, as safely, effectively and quickly as possible. We must reimagine a new social contract for health, that protects citizens and non-citizens in fair, sustainable and politically acceptable ways. We can integrate our non-health and health infrastructure to enable better contact tracing, such as South Korea's use of credit card transactions and China's use of QR codes. We need a true whole-of-society response.

In the first year, governments can be forgiven for relying on what they are familiar with. In the second year, governments must respond to Covid-19 in much bigger ways. This once-in-a-lifetime problem requires once-in-a-lifetime solutions. Only then can we beat this pandemic.

The Covid-19 pandemic will define not just 2020, but the 2020s. The strategic choices we make in 2021 will define how effectively Malaysia manages Covid-19 and recovers from it. This new year let us make three resolutions as a country: to use our time wisely, to stabilise our tolerance of risk, and to bring ambitious giant solutions to a giant problem. — Sin Chew Daily/Asia News Network

Dr Khor Swee Kheng is an independent consultant for the World Health Organisation. The views expressed here are solely his own and do not necessarily reflect those of The Star. 

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Friday, 1 January 2021

Happy New Year 2021: Stay Home to stay Safe


https://youtu.be/Qt0dAbyjU-c


https://youtu.be/nDJKtzUcXyU



Health experts say the current Covid-19 situation in the country is not favourable for social gatherings even for welcoming the New Year.

“Current active cases have exceeded 21,000 and daily numbers are close to 2,000. We should not expose ourselves to any risk of infection,” said Universiti Putra Malaysia medical epidemiologist Assoc Prof Dr Malina Osman.

“We should also not strain our healthcare system further.”

The conditional movement control order (MCO) was eased for the sake of the country’s economy, and not for engaging in big social crowds or family gatherings, said Dr Malina.

She advised the public to continue to comply with SOP, as the vaccine was yet to be made available locally.

“Hopefully the vaccine will reach our country soon. Singapore has started the vaccination for their frontliners today (yesterday) and their cases are much lower compared to us, we have to be more consistent and vigilant against Covid-19.

“Or we can expect early next year to be markedly different from our neighbouring country,” she said.

Universiti Malaya professor of epidemiology and public health Prof Dr Sanjay Rampal said for the next few weeks, it was important to do two things.

“First, avoid being in congested and confined areas for prolonged durations. It may be hard at times to maintain the minimum 1m physical distancing but we have to.

“Second, there may be a need to maintain a social circle for longterm emotional and psychosocial support, but avoid a large bubble, and restrict mixing across networks,” he said.

For New Year celebrations, Dr Sanjay suggested that the public usher in the New Year by staying at home.

Large gatherings, if any, should be held in big, open spaces while practising physical distancing, he said, adding that the location should have sufficient amenities to promote good sanitation and hygiene.

Medical Practitioners Coalition Association of Malaysia president Dr Raj Kumar Maharajah concurred that celebrations should be held in open areas with good ventilation to reduce the probability of getting infected.

Dr Raj said air conditioned and closed spaces without good ventilation posed a risk to people.

“Malaysians can celebrate in open areas by observing the SOP laid out by the Health Ministry. Use your face mask, observe social distancing, and wash and sanitise your hands regularly,” he said.

Going into the new year, Dr Raj believed there would not be “total freedom”.

“There will still be restrictions for the whole of next year. Hopefully, the vaccine can ease that for us. However, let’s remain positive and hope for the best,” he said.

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These calf raises required no equipment and one of the simplest exercises to tone your muscles - STOP Calf Pain 

 

    Effortless Effort—The Eat-All Greens Garden https://youtu.be/9a-dUO7Qn58   

 

 Sheer joy of parenting

Tuesday, 29 December 2020

Core Exercises for Stroke Patients to Improve Balance and Walking (Gait)


https://youtu.be/dGBqTLtdVuA 



Seated Core Exercises


https://youtu.be/twZ1hnetOP8


13.9K subscribers

The best way to improve balance after stroke is with core exercises. You can also download 13 pages of free rehab exercises here: https://flnt.rehab/2JGii7r

These core exercises for stroke patients are guided by Cassi, DPT (Doctor of Physical Therapy).

Cassi's core exercises are relatively easy and will help you improve your balance and gait (manner of walking).

To get more information on stroke recovery, download our FREE ebook here:https://flnt.rehab/2zg3yt0

Best Hand Exercises for Stroke Patients at Home

https://youtu.be/i0JYsLyJEnE 

These hand exercises for stroke patients are guided by Barbara, OTA. You can also download 13 pages of free rehab exercises here: https://flnt.rehab/2JGii7r



Best Stroke Recovery Hand Exercises - Stage 1


https://youtu.be/ZKR1nOtCNKU 

Dr. Scott Thompson shares the best stroke recovery hand exercises. Use these hand exercises and hand therapy tools to advance your stroke recovery. 

Full Body Rehab Exercise Guides

Thanks for signing up for our free stroke rehab exercises. To download the PDF exercise guides ebook, click the button below:

Download My Free Rehab Exercise Ebook!

We hope you get good use from the ebook!

Now let's back up a bit... Who is the company behind the stroke recovery blog and ebook?

Hello there!

We are so happy to have you here. We are Flint Rehab, and we're pretty passionate about stroke rehabilitation.

And we're even more passionate about helping stroke survivors just like you achieve a higher recovery.

Because we believe that...

  • ...You can defy the odds and achieve a higher recovery - if you believe in yourself.
  • ...Stroke education is of the utmost importance because it can help you achieve that higher recovery. 
  • ...Emotional healing is just as important as physical healing, so we always talk about both.
  • ...Regaining movement after stroke does not have to be boring.

That's why we pour so much energy into both maintaining an extensive stroke education blog and creating fun, effective rehabilitation devices.

What to Expect from Us

To help boost your stroke education, we send a newsletter every Monday that contains brand new stroke recovery articles.

Two of them are usually brand spankin' new, and the other 3 are goodies pulled from the archives.

Since our archives contain 300+ stroke recovery articles, our Monday newsletter is the best way to stay on top of our best stuff.

Do you think we're a good match?

If so, we'll help catch you up to speed by sending you a quick lesson on the best way to massively improve movement after stroke.

If you aren't interested, we understand. You can opt out here or at the bottom of any email at any time. No hard feelings!

For those who stick around, we're really happy to have you here!

Your resource for recovery,
​The team at Flint Rehab

NGOs hold free online classes on managing stress

A ‘Body Mind Powerbank Station’ class being held over Zoom.

TWO humanitarian non-governmental organisations are jointly holding free online classes on techniques to alleviate stress.

The Art of Living (AOL) Malaysia and International Association for Human Values (IAHV) will hold the classes, themed “Body Mind Powerbank Station”, to teach participants the proper stretching and breathing techniques that can assist people in dealing with anxiety, especially those induced by the Covid-19 pandemic and movement control order.

The classes are 20 minutes’ long and will be conducted via Zoom every Wednesday to Friday between 8pm and 9.30pm.

AOL Malaysia president Sundaresh Aw Yang said the techniques would help calm minds.

“The MCO has disrupted many lives, resulting in sleep disorder, anxiety, lost of concentration and increased anger that take a toll on the body.

“This programme, started in October, will help participants to relax and improve their energy, ” he said when contacted.

“Normal breathing will see about 20% of the oxygen we inhale go to our lungs.

Breathing Relaxation Exercise

https://youtu.be/-j5Z4E2wkh4

15 Minute Deep Breathing Exercise

https://youtu.be/F28MGLlpP90

 “Through the techniques to be taught in the classes, we can bring it up to about 70% to 80%.

“People who are angry will breathe heavily and in short breaths. Those who are happy will breathe lightly, long and deep, ” he added.
     Aw Yang said with better breathing, it would also help improve quality of sleep.

He said the techniques were started by AOL founder Ravi Shankar from India in 1981.

“It can help people to be more positive and have a peaceful mindset, ” he said, adding that there were 156 AOL centres globally and 50 in Malaysia.

IAHV president Tan Boon Yang said he had been practising the techniques for 15 years and found it to be beneficial.

“People commonly advise us to rid ourselves of anxiety and not be angry, but fail to guide us on how to do so.

“I had depression and the techniques have helped me to manage my anxiety, ” he said.

“I am now actively involved in humanitarian efforts.

“The techniques are very simple and I hope it can work for others too, ” he said.

He added that IAHV was a global organisation found in 25 countries, with its branch in Malaysia registered in 2012.

To register for the classes, http://tiny.cc/BodyMindEnglish

For further details, www.my-iahv.org or www.artofliving.org.my or call 012-413 0890 or 011-6168 2171.

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Sunday, 27 December 2020

That calf of yours


These calf raises required no equipment and one of the simplest exercises to tone your muscles - photo: 123rf.com


STOP Calf Pain | Best Stretches For Calves

https://youtu.be/D327Pwt-ONs

11 Easy Exercises to Slim Your Legs In 2 Weeks

https://youtu.be/YGTCKQU4E7Y


 

Some like them big, some like them small, but either way, the size of your calves can tell a lot about your health.

MEN take pride in having them big, but women want them slender.

It’s a skeletal muscle group that’s difficult to bulk or trim, even though it’s one of the most used in daily tasks.

If you’re unsure which muscles these are, I’m referring to the calves.

Genetics and anatomical structure play a significant role in how the muscle is shaped and how large it can grow.

The calves comprise of two main muscles: the outer gastrocnemius (known as the calf belly with two “heads”, i.e. medial head and lateral head), and the underlying soleus, which is the smaller of the two.

Together, they are responsible for bending the ankle joint upwards (dorsiflexion) and straightening it to point your toes (plantarflexion).

These two muscles taper and merge at the base of the calf muscle, and attach to the heel bone (calcaneus) via the Achilles tendon.

During walking, running or jumping, the calf muscles pull the heel up to allow the body to propel forward.

There is also another small muscle that runs beneath the gastrocnemius and soleus, called the plantaris.

It has a short belly and a long, thin tendon that connects to the Achilles tendon.

Functionwise, the plantaris muscle assists the gastrocnemius, but not significantly.

In fact, in 10% of the population, this muscle is completely absent.

Bigger or smaller?

Basically, the size of your calf muscles is determined by how far your heel bone (calcaneus) projects backwards, i.e. its length.

The longer this bone is, the smaller your calves.

In one 2011 study, researchers studied individuals of similar height, weight, lower limb length and foot length, and discovered that the ones with shorter calcanei had bigger calves.

Meanwhile, those with longer calcanei had more slender calves.

They also looked at the muscle recruitment patterns and found that people with shorter heels and big calves were using their medial gastrocnemius muscle more than the lateral gastrocnemius muscle while walking.

In contrast, those with longer calcanei had more evenly distributed calf contractions.

People with skinny ankles (small girth) will not be able to build bulk in their calves, although they have a lot more agility than their counterparts with thicker ankles.

Sprinters generally have bigger calves due to the extraordinary amounts of explosive power required to sprint short distances.

Long distance runners, on the other hand, tend to have slender, toned calf and leg muscles.

In fact, the calves in animals that move fast are practically non-existent.

Sausage legs

There is no ideal or normal proportion for the calves and ankle – it depends on what is beautiful to the eye.

Aesthetically, we are all wired to desire ankles that are smaller than the calves.

However, there is a condition where the ankle is just as thick or slighter thinner than the calf, making the lower leg look like a cylinder.

This “cankle” – a combination of the words “calf” and “ankle” – is not a medical term, but a word made popular in 2001 when Jason Alexander’s character in the movie Shallow Hal used it to criticise an overweight woman’s lower leg, saying, “It’s like the calf merged with the foot, cut out the middleman.”

When you have cankles, you’ll find it hard to differentiate the calf from the ankle. Some people call this “sausage legs”.

Women are more prone to this as it seems to run in the female line, with mothers, sisters and other female relatives tending to have the same lower leg shape.

Unfortunately, there is just so much you can do to alter it through natural means besides losing the fat that is covering the ankle.

Sometimes, however, these cankles are due to medical conditions like excessive water retention, kidney disease, bad sprains and surgery.

The calves are prone to tightening and cramping, especially after a workout, so be sure to stretch them out.

If your ankles remain swollen over a long period, do seek medical advice as it could be the sign of something sinister, like heart failure.

Managing those muscles

If you’re genetically predisposed to having big calves and don’t want to bulk further, the best you can do is to scale back on high intensity, skipping, plyometric and heavy weight-bearing exercises as they contribute to hypertrophy or muscle growth.

Also, don’t walk, hike or run up on an incline (e.g. hills or uneven surfaces) as these activities force your calf muscles to work harder.

They will definitely get stronger, but could also get bigger.

Instead, stick to running on flat surfaces.

To build your calf muscles, there are only two types of effective, yet simple exercises: heel or calf raises with knees straight (for the gastrocnemius) and with knees bent (for the soleus).

Start with one set of 12-15 repetitions with your feet parallel first.

Then turn your feet out (toes pointed out or away from the body) for the next set.

For the last set, turn your feet in. This forces your muscles to work from different angles.

To target the soleus muscle, repeat the entire sequence seated, perhaps with a light dumbbell on your thighs.

Do three sets, but only with your feet parallel.

You may not see noticeable bulk, but you’ll see some tone and more definition.

Stretch and soak

The calves are prone to tightening and cramping, especially after a workout, so be sure to stretch them afterwards.

The simplest way to do this is to stand at the edge of a step and place the balls of your feet on it.

Keep your legs straight (use the wall or railing for support) and reach your heels to the floor until you feel the stretch in your calves and Achilles tendon. This stretches your gastrocnemius muscles.

To stretch your soleus, do this with one knee bent, then repeat on the other side.

In addition, you can try soaking your lower leg in warm, salt water for 15 to 20 minutes before patting dry with a towel.

Then, apply some oil or lotion to self-massage the calves using stroking motions towards your hip.

Depending on your preference, you can use your fingers, palms, heel of your hand or knuckles.

Strong pressure reduces tension and pain in your muscles, while using a light pressure is more relaxing, especially before you retire for the night.

Benefits in all sizes

Fret not if your calves are big because there are some health benefits associated with it, according to a 2008 study published in the Stroke journal.

Apparently, regardless of age, gender, body mass index (BMI) and other vascular risk factors, those with bigger calves have fewer fatty deposits known as plaques built up in their arteries, thus lowering their risk for stenosis, carotid artery disease and strokes.

Researchers suspect this may be because big calves give the body another place to store fat that could cause problems when they’re floating in the bloodstream.

At the same time, people with bulky calves could also be more prone to non-alcoholic fatty liver disease as the calves act as a proxy for fat deposits.

In a 2013 study in the Journal of Physical Therapy Science, researchers concluded that the smaller a person’s calves are, the higher their resting heart rates might be.

In general, high resting heart rates, or anything above 100 beats per minute, have been linked to an increased risk of death, regardless of physical fitness.

A normal resting heart rate for adults ranges from 60 to 100 beats per minute.

A lower heart rate at rest implies more efficient heart function and better cardiovascular fitness.

So, all is fair whether you have big calves or small.

On that note, here’s to a brighter 2021!

By Revathi Murugappan, who is a certified fitness trainer who tries to battle gravity and continues to dance to express herself artistically and nourish her soul. For more information, email starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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