in children COMBATING OBESITY by gyvwpsjkko


									  30th EDITION                                                                                   March 2010

OBESITY in children
          ccording to the World Health             number of factors have been identified that

A         Organisation, overweight and
          obesity are defined as abnormal
or excessive fat accumulation that
presents a risk to health. A crude
                                                   contribute to this epidemic of childhood

                                                   Genetic make-up
population measure of obesity is body              If one or both parents of a child are
mass index (BMI). This is calculated by            overweight or obese, the child will be more
dividing a person's weight (in kilograms)          susceptible to gaining weight. Research shows
by the square of his or her height (in             that a genetic component explains 50 to 60%
metres). A person with a BMI of 30 or              of the variations in abdominal fat content in
more is generally considered obese. A              different individuals.
person with a BMI equal to or more
than 25 is considered overweight.                  Genetic versus environmental factors
                                            Genetic factors are only partially responsible
Overweight and obesity are                                 for the development of
major risk factors for a                                   obesity. Children with lean
number of chronic                                          genes may also become obese
conditions, including                Remember to           if they are exposed to what
diabetes, cardiovascular                                   is known as an energy-
diseases and cancer. Once
considered a problem only        balance an       active   overload or over-abundance
                                                           of high-energy foods.
in high-income countries,
overweight and obesity are
now dramatically on the rise      lifestyle for your               Ethnicity
in low- and middle-income                                          Certain population groups
countries, particularly in         child with a healthy            are more inclined to gain
urban settings.                                                    weight than others when they
                                             diet.                 are exposed to a high-fat
More than 17% of South                                             western diet. This
African children between the                                       phenomenon has been
ages of one and nine living                                        observed repeatedly when
in urban areas are overweight, according to       populations exchange their high-fibre, low-
a report by the Medical Research Council of       fat eating habits to high-fat, high-energy diets
South Africa. This is of great concern as         as part of urbanisation and westernisation.
American studies have found that overweight
or obese children tend to remain overweight       In South Africa we are experiencing this kind
or obese to the age of 20 and are exposed         of transition on a daily basis as more and
to a 1.5 to 2 times higher risk of being obese    more rural people leave their villages to move
adults. Obese adults in turn face the risk of     to cities. When rural children become
increased heart disease, diabetes, joint and      city dwellers their diets undergo
gall-bladder disease, and a lifetime of trying    a radical change as they
to shed those unwanted kilograms.                 substitute grains,
                                                  fruits, vegetables
Contributing factors                              and sour milk for             PREVIOUS WINNERS
                                                                                Congratulations to all the winners of the 29th edition (September 2009) of Infobulletin.
In the United States of America (USA) a            Continues on page 2…
                                                                                JOIN THE DOTS (JUNIOR)                        First prize:
                                                                                The winners from the junior competition       Elisa Modisaemang,
                                                                                                                              member number 4477100
                                                                                                                              Second prize:
                                                                                Yureshlin Perumal, member number              Rhona Margery Desjardins,
COMBATING OBESITY IN CHILDREN      THE 2010 SOCCER EXPERIENCE                                                                 member number 2319446
                                                                                4359950 and Pauline Moss, member
PETRUS'S PEN                       HOW TO USE YOUR CARE PLAN                                                                  Third prize:
                                                                                number 004055490. Both winners will
                                   MAHALA                                                                                     Nicolaas Spang,
MAKING YOUR NEW YEAR'S                                                          receive a TOYS " " US voucher to              member number 4619750
RESOLUTION STICK                   EASY EXERCISES TO DO IN THE                  the value of R350.
                                   COMFORT OF YOUR HOME                                                                       The winners will receive a Pick 'n Pay
MEMBER NOTICEBOARD                 DETOX DIETS                                                                                gift card. The first prize winner will receive
                                                                                WORD SEARCH PUZZLE (ADULTS)
                                                                                                                              a gift card to the value of R2300 and the
THE DANGERS OF ULTRAVIOLET         COMPETITIONS FOR YOUNG                       The winners from our adult competition        second and third prize winners will each
EXPOSURE                           AND OLD
                                                                                are:                                          receive a gift card to the value of R1000.
P E N                                                                    COMBATING OBESITY IN CHILDREN… Continues from page 1
                  Welcome to this information-packed edition of          high-energy snack foods and cold drinks.           of increasing knowledge and
                  the Infobulletin.                                      Ironically, malnutrition and obesity often         awareness of nutrition and physical
                                                                         occur in members of the same family                activity issues.
                  I trust you have all made your benefit plan changes    living in disadvantaged communities.               Children should be encouraged to
                  where necessary and that you are enjoying a                                                               keep water bottles at their desk in
                  renewed energy and zest for life in this new year,     Lack of physical activity                          order to enable them to increase
                  which will see our country host the much                                                                  their water intake during the day.
                  anticipated FIFA World Cup!                            Modern children, in contrast to their              Ensure that children eat breakfast
                                                                         counterparts of 30 years ago, have                 daily! Studies reveal that children
                  A new year tends to bring with it a desire for         become couch potatoes. They expend                 who skip breakfast are less attentive
P E T R U S ' S

                  change. This year the Infobulletin will embrace        much less energy on physical activity than         and lack concentration during
                  the theme of healthy living. Throughout the year       ever before. Endless hours of watching             classroom time and also tend to make
                  we will inform you about the latest news on            television and playing computer games              unhealthy food choices during meal
                  physical fitness, diet and nutrition as well as        are probably the major culprits.                   times.
                  emotional wellness.                                                                                       A healthy lunchbox should consist of
                                                                         However, many schools also do not have             a whole-wheat/wholegrain starch
                  In this edition we focus on how to make your           the facilities to permit all their pupils to       with a lean protein filling and a fruit
                  New Year's resolution stick and provide you with       participate in sport and other schools             or vegetable. Drinks should consist
                  information on detox diets and easy exercises          only concentrate on their best athletes,           of water, a fruit juice or a low-fat
                  that you can do in the comfort and convenience         while the majority of less sporty children         drinking yoghurt.
                  of your home.                                          are made to sit on the sidelines.                  Choose healthier snacks for your
                                                                                                                            children. Examples include reduced
                  People's behaviour in the sun is the main cause        Changing eating habits                             fat cheese slices on whole-wheat
                  for the rise in skin cancer rates in recent decades.                                                      crackers, low-fat custard and fruit,
                                                                         The trend of eating more meals at                  baked beans on toast, rice cakes,
                  An increase in popular outdoor activities and
                                                                         restaurants; buying take-away foods and            low-fat home-made popcorn, bran
                  changed sunbathing habits often result in excessive
                                                                         high-energy snacks; the increased                  or fruit muffins, fresh or dried fruit
                  ultraviolet (UV) exposure. Many people consider
                                                                         availability of kilojoule-laden foods at           and low-fat yoghurt.
                  intensive sunbathing to be normal and perceive
                                                                         every turn, including tuck shops; large            Try creative ideas to help increase
                  a suntan as a symbol of attractiveness and good
                                                                         portion sizes and skipping meals due to            consumption of fruit and vegetables
                  health. However, a suntan is merely a sign of UV
                                                                         lack of time, not only contribute to               by preparing it differently and varying
                  damage and represents the skin's defence to
                                                                         obesity in adults but also in children.            the texture. Instead of always
                  prevent further harm.We will look at the dangers
                  of UV exposure in this edition and expose the                                                             steaming, rather bake, grill, mash,
                  truth behind the myths that we embrace about           Psychological factors                              microwave or even blend into soups
                  sunbathing.                                            Many parents express their love for their          or a pasta sauce.
                                                                         children through food. "Eat up, your mom           Limit television time to less than two
                  Children throughout South Africa returned to           made this dinner especially for you."              hours per day and get your children
                  schools in January and are in the full swing of        "Don't cry, have a sweetie." Should you            more active! Children should aim for
                  activities for the year. One of the major issues       have a problem expressing your love for            at least 60 minutes of physical activity
                  gaining increased media attention is obesity           your children, do not use this confusing           daily. It does not have to be done all
                  amongst children. Childhood obesity is fast            type of coercion, as it may cause children         at once, but throughout the day.
                  becoming a growing and concerning phenomenon,          to equate food and love later in life and          Parents or caregivers should be active
                  further fuelled by a couch potato culture in           lead to weight gain every time they feel           role models and should have a
                  children. In this edition we will give you practical   unloved or have to cope with a crisis.             positive attitude to being active. If
                  tips designed to help your child develop a healthy     Other parents try to exert control over            children see you enjoying physical
                  lifestyle.                                             their children by means of food. "Think            activity, they will be more likely to
                                                                         of the starving children in the world and          participate.
                  In December 2009 you were informed about               clean your plate!" Using guilt in order to
                  Transmed's new private benefit plans for Transnet      persuade children to eat is a destructive      Remember to balance an active lifestyle
                  Working Members and Transnet Pensioners in             approach that may distort their concept        for your child with a healthy diet by
                  2010, namely the Private Network Core benefit          of food for the rest of their lives.           limiting foods that are high in saturated
                  plan and Private Network Saver benefit plan.The                                                       fat, sugar and salt. Teach children healthy
                  Fund has contracted a Private Hospital Network         The alarming statistics mentioned above        eating habits that will last their entire
                  for these private plans in order to manage             need to be taken seriously and we should       lifetime!
                  member contributions. Some members stay in             do everything in our power to prevent
                  areas where there are no network hospitals and                                                        SOURCES:
                                                                         South African children from succumbing
                  the Fund has negotiated alternative arrangements       to the obesity epidemic.                           Accessed in October 2009
                  for these members. Members on these benefit                                                     
                  plans should contact the Transmed managed care                                                            Parenting/HealthandNutrition/2574/f19
                  line on 0800 225 151 for more information on           Ideas to support healthy                           957184d4c42b7a7e5f37c8e8adc76/13-
                  hospital pre-authorisation and admissions as well                                                         10-2008-12-08/Obesity_in_children_
                                                                         lifestyles for children
                  as to enquire about access to their nearest                                                               Accessed in October 2009
                  hospital.                                                  The school tuck shop/canteen should  
                                                                             provide healthy food choices.                  factsheets/fs311/en/index.html
                  I trust that you and your                                  Establish a vegetable garden and get           Accessed in October 2009
                  family will have a healthy                                 children involved in the planting and
                  and prosperous year.                                       nurturing of fruit and vegetables. This        community.htm
                                                                             will encourage children to learn about
                                                                                                                            Di Caelers,There is a solution for overweight
                  Happy reading!                                             different fruit and vegetables.                children, Pretoria News, 26 April 2005,
                                                                             The school can look into developing            p. 10
                                                                             a school orientation package that will
                                                                                                                            Accessed in October 2009
                                                                             provide and educate parents and
                                                                             caregivers about healthy eating and            Weight_Centre/15-51-2954-
                  PETRUS                                                     physical activities for children.              2959,31685.asp
                  WASSERMANN                                                 Nutrition articles can be included in
                                                                             the school newsletter with the aim             Dr IV van Heerden, DietDoc
                  PRINCIPAL OFFICER

Lose weight? Check. Start exercising? Check.
Stop smoking? Check. It can be daunting
                                                      Specific - specifics help us to focus
                                                                                                          with something else you enjoy, like fruit
                                                                                                          or yoghurt, instead of seeing your diet
when your list of New Year's resolutions is           our efforts and clearly define what we              as a form of punishment.
as long as your holiday shopping list. In             are going to do. Specific is the what,              Change one behaviour at a time -
addition to the post-holiday slump, not being         why and how questions that will get                 unhealthy behaviours develop over the
able to keep your resolutions by late January,        you started.                                        course of time. Thus, replacing unhealthy
February or even March may increase your              Measurable - if you cannot measure                  behaviours with healthy ones require
anxiety. When your holiday decorations are            it, you cannot manage it.                           time.
packed up and stored away, the frustration            Attainable - a goal needs to stretch                Talk about it - having someone to share
of an unused gym membership or other                  you slightly so you feel you can do it              your struggles and successes makes your
reminders of failed resolutions can make the          and it will need a real commitment                  journey to a healthier lifestyle that much
later winter months feel hopeless.                    from you.                                           easier and less intimidating
                                                      Realistic - this is not a synonym for               Don't beat yourself up - perfection is
However, it is important to remember that             easy. Realistic, in this case, means "do-           unattainable. Remember that minor
the new year is not meant to serve as a               able".                                              missteps are perfectly normal when
catalyst for sweeping character changes. It           Timely - set a timeframe for the goal.              reaching your goals.
is a time for people to reflect on their past         Putting an end point to your goal gives             Ask for support - accepting help from
year's behaviours and promise to make                 you a clear target to work towards.                 those who care about you and will listen,
positive lifestyle changes. "Setting small,                                                               strengthens your resilience and ability
attainable goals throughout the year, instead      By making your resolutions smart, there is             to manage stress caused by your
of a singular, overwhelming goal can help          a greater chance that you will keep them               resolution. If you feel overwhelmed or
you reach whatever it is you strive for," says     throughout the year, incorporating healthy             unable to meet your goals on your own,
psychologist Lynn Bufka, PhD. "Remember,           behaviour into your everyday life.                     consider seeking professional help.
it is not the extent of the change that matters,                                                          Psychologists are uniquely trained to
but rather the act of recognising that lifestyle   The American Psychological Association                 understand the connection between the
change is important and working towards it,                                                               mind and body. They can offer strategies
                                                   (APA) offers these tips when thinking about
one step at a time."                                                                                      as to how to adjust your goals so that
                                                   a New Year's resolution:
                                                                                                          they are attainable and help you change
                                                                                                          unhealthy behaviours and address
SMART GOALS                                           Start small - make resolutions that you
                                                                                                          emotional issues.
                                                      think you can keep. If, for example, your
S = Specific
                                                      aim is to exercise more frequently,              SOURCE:
M = Measurable
                                                      schedule three or four days a week at              Accessed in November 2009
A = Attainable
                                                      the gym instead of seven. If you would             The American Psychological Association -
R = Realistic
                                                      like to eat healthier, try replacing dessert
T = Timely

  Nationwide walk-in centres                       JOHANNESBURG: Ground Floor                        BLOEMFONTEIN: Shop 18, Southern
                                                   (Main Entrance), 101 De Korte Street,             Sentrum, Benade Street, Fichardt Park,
  Transmed has walk-in centres in almost all       Braamfontein                                      Bloemfontein
  the major cities in the country. Should you
  prefer to speak to someone about your            OR TAMBO: Airways Building, OR Tambo              The walk-in centres are open weekdays
  Transmed Medical Fund queries on a face-         International Airport, Johannesburg               from 08.00am to 16.30pm.
  to-face basis, you are welcome to visit any
  of the walk-in centres. The walk-in centres      DURBAN: 391 Smith Street, Fourth Floor,
  are there to attend to all your Transmed         Metropolitan Building, Durban                     Marketing activities
  Medical Fund enquiries, such as registration,
  benefit plan changes and statement queries,      PRETORIA: Nedbank Plaza, cnr Church               Members are encouraged to visit the Transmed
  and are located at the following venues:         and Beatrix Street, Arcadia, Pretoria             website at and view the
                                                                                                     Marketing Activities page for a
  CAPE TOWN: Shop 101, N1 Value                    PORT ELIZABETH: Ground floor, FC                  comprehensive calendar that contains details
  Centre, Solly Smiedt Street, Goodwood,           Sturrock Building, cnr Fleming and Strand         of our marketing team's visits and health
  Cape Town                                        Street, Port Elizabeth Central                    days in your area.

Ultraviolet (UV) radiation                                            How sunrays damage your skin                                  as quickly as possible. This damage                step of the formation of cancer cells.
                                                                                                                                    and repair happens all the time, and       Step 5: UV rays also encourage extremely
Emissions from the sun include light, heat and UV                     Step 1: The UVA and UVB rays penetrate                        the tempo of repair can keep up with               toxic superoxides to accumulate in
radiation. UV radiation reaching the earth's surface                          the clouds, thick layers of glass, a                  a certain amount of damage. The                    the cells.
is largely composed of UVA with a small UVB                                   metre of water, and the layers of the                 repair enzymes can get tired or just       Step 6: These superoxides speed up cell
component. UV radiation levels are influenced by:                             skin.                                                 not be enough.                                     ageing.
                                                                      Step 2: The UV rays act like chain saws,              Step 4: When the damage is excessive (and          Step 7: It appears that selenium prevents the
     Sun elevation: the higher the sun in the sky,
                                                                              shredding the DNA (the genetic                        this can be even before your skin                  build-up of superoxides and that
     the higher the UV radiation level. Thus UV
                                                                              material, with a very precise                         turns red), the enzymes cannot cope.               antioxidants such as vitamins A, E
     radiation levels vary with time of day and time                          structure, very specific order and                    The result is a scrambled DNA                      and C may also protect the DNA.
     of year.                                                                 very specific coding) of the cell nuclei.             structure and scrambled coding,            Step 8: Benign freckles and sunspots may
     Latitude: the closer to equatorial regions, the                  Step 3: Repair enzymes in the cell try to                     which leads to normal cells going                  need just one extra exposure to the
     higher the UV radiation levels.                                          repair the damage to the DNA chain                    haywire (mutate). This is the first                sun to become malignant.
     Cloud cover: UV radiation levels are highest
     under cloudless skies but even with cloud
     cover, they can be high.                                         Some common myths
     Altitude: at higher altitudes, a thinner                              FALSE                                          TRUE
     atmosphere absorbs less UV radiation.                                 A suntan is healthy.                           A tan results from your body defending itself against further damage from UV radiation.
     Ozone: ozone absorbs some of the                                      A tan protects you from the sun.               A dark tan on fair skin only offers an SPF of about 4.
     UV radiation that would otherwise
                                                                           You cannot get sunburnt on a cloudy day.       Up to 80% of solar UV radiation can penetrate light cloud cover. Haze in the atmosphere can
     reach the earth's surface.                                                                                           even increase UV radiation exposure.
     Ground reflection: grass, soil and water
                                                                           You cannot get sunburnt while in the           Water offers only minimal protection from UV radiation and reflections from water can
     reflect less than 10% of UV radiation; fresh                          water.                                         enhance your UV radiation exposure.
     snow reflects as much as 80%; dry beach sand                          Sunscreens protect me so I can sunbathe        Sunscreens are not intended to increase sun exposure time but to increase protection during
     about 15% and sea foam about 25%.                                     much longer.                                   unavoidable exposure. The protection they afford depends critically on their correct application.
                                                                           If you take regular breaks during              UV radiation exposure is cumulative during the day.
Major health concerns                                                      sunbathing you will not get sunburnt.
                                                                           If you do not feel the hot rays of the sun     Sunburn is caused by UV radiation, which cannot be felt. Most of the heating is caused by the
Exposure to the sun is known to be associated                              you will not get sunburnt.                     sun's visible and infrared radiation, and not by UV radiation.
with different types of skin cancer, accelerated skin
ageing, cataract and other eye diseases. There
is also evidence that UV radiation reduces the
effectiveness of the immune system.
                                                                      Skin cancer incidence on the                          melanoma skin cancers increased by a factor        characteristics, and a person's UV exposure
                                                                                                                            of more than two.                                  behaviour. The following is a summary of
                                                                      rise                                                                                                     the main human risk factors:
Vulnerable groups                                                     Between 2 and 3 million non-melanoma skin             The risk of non-melanoma skin cancers has              A large number of atypical nevi (moles)
                                                                      cancers and approximately 132 000 malignant           been examined with respect to personal                 is the strongest risk factor for malignant
Children are particularly sensitive to UV radiation                                                                         exposure, and the following conclusions can            melanoma in fair-skinned populations.
                                                                      melanomas occur globally each year. With
and require special protection. More than 90% of                      a sustained 10% decrease in stratospheric             be drawn:                                              Malignant melanoma is more common
non-melanoma skin cancers occur in fair skinned                       ozone, an additional 300 000 non-melanoma                 Non-melanoma skin cancers are most                 among people with a pale complexion,
people who tend to burn. However, even though                         and 4500 melanoma skin cancers could be                   frequent on parts of the body that are             blue eyes and red or fair hair.
the incidence of skin cancer is lower in dark skinned                 expected worldwide, according to United                   commonly exposed to the sun, such as               High intermittent exposure to solar UV
people they are nevertheless susceptible to the                                                                                 ears, face, neck and forearms. This implies        appears to be a significant risk factor for
                                                                      Nations Environment Programme (UNEP)
damaging effects of UV radiation, especially to the                                                                             that long-term, repeated UV radiation              the development of malignant melanoma.
                                                                      estimates. People's behaviour in the sun is
effects on the eye and immune system.                                                                                           exposure is a major causal factor.                 Several epidemiological studies support
                                                                      the main cause for the rise in skin cancer
                                                                                                                                Within some countries there is a clear             a positive association with history of
                                                                      rates in recent decades. An increase in                   relationship between increasing incidence          sunburn, particularly sunburn at an early
The basic sun protection messages                                     popular outdoor activities and changed                    of non-melanoma skin cancers with                  age.
                                                                      sunbathing habits often result in excessive               decreasing latitude, i.e. higher UV                The role of cumulative sun exposure in
    Limit exposure during midday hours.                               UV exposure.
    Seek shade.                                                                                                                 radiation levels.                                  the development of malignant melanoma
                                                                                                                                                                                   is equivocal. However, malignant
    Wear protective clothing. Wear a broad
                                                                               Non-melanoma skin cancers                    Malignant melanoma                                     melanoma risk is higher in people with
    brimmed hat to protect the eyes, face and neck.
                                                                                                                                                                                   a history of non-melanoma skin cancers
    Protect the eyes with wrap-around-design                                   Non-melanoma skin cancers comprise           Malignant melanoma,                                    and of solar keratoses, both of which are
    sunglasses or sunglasses with side panels.                                 basal cell carcinomas and squamous           although far less prevalent                            indicators of cumulative UV exposure.
    Use and reapply broad-spectrum sunscreen of                                cell carcinomas. These are rarely lethal     than non-melanoma skin
                                                                               but surgical treatment is painful and                                          Malignant
    sun protection factor (SPF) 15+ liberally.                Basal cell                                                    cancers, is the major cause       melanoma         SOURCES:
    Protect babies and young children.                       carcinoma         often disfiguring. The temporal trends       of death from skin cancer                            Accessed in October 2009
                                                                               of the incidence of non-melanoma skin        and is more likely to be reported and      
                                                                               cancers are difficult to determine,          accurately diagnosed than non-melanoma               Focus_centres/777-2268-3749-
                                                                               because reliable registration of these       skin cancers. Since the early 1970s, malignant
                                                                               cancers has not been achieved.               melanoma incidence has increased                       Accessed in October 2009
                                                                               However, specific studies carried out        significantly, for example an average 4% every         factsheets/fs261/en/
                                                            Squamous cell      in Australia, Canada and the USA             year in the USA. A large number of studies             Accessed in October 2009
                                                             carcinoma         indicate that between the 1960s and          indicate that the risk of malignant melanoma 
                                                                               the 1980s the prevalence of non-             correlates with genetic and personal                   factsheets/fs271/en/

The FIFA World CupTM is the biggest sporting      least 500 000 overseas visitors plus additional    has a preparedness plan based on the
event in the world. It is a unique window of      visitors from the African continent, there         following key areas: Communicable and Non-
opportunity for Africa and South Africa. This     will be a great deal of human and traffic          Communicable Diseases, Food Control,
long anticipated event is on a level unlike       congestion across all modes of transport in        Emergency Medical Services and Port Health.
anything that South Africa has staged.            host cities. Roads may be blocked for up to
                                                  eight hours before the commencement of a           In light of all of the disturbances to the
Germany, the previous hosts of the FIFA           match in both the stadia and the free fan
World Cup TM , experienced two million                                                               normality of life, business and healthcare
                                                  parks. Cellular phone networks and internet
visitors from 194 nations, 3.36 million                                                              services, we encourage you not to book any
                                                  speed will be compromised due to high
spectators in 12 stadiums and 18.4 million                                                           medical procedures during this time if
spectators at 15 Fan Fests in the 12 host         volume demand by supporters and the media.
                                                                                                     possible. The Fund has set up a project team
cities. Business functioned in a relaxed manner                                                      to consult on the communication processes
similar to that experienced annually during       The human and traffic congestion will place
                                                  added pressure on healthcare services that         between the Fund and members to help
the year-end holiday season.
                                                  will be dealing with larger numbers of people      ensure that good client service to our valued
In South Africa, the matches will run from        from across the world. The influx of foreign       members can continue during this period.
11 June to 11 July 2010, with FIFA officials      visitors brings with it a number of health risk    Further communication with regard to this
arriving earlier. With 25 free fan parks and      factors that need to be anticipated. In            will be mailed to members in the build up
public viewing sites in the host cities, and at   response to this, the Department of Health         towards the FIFA World CupTM.

Prescribed Minimum Benefits (PMBs) are a          What is a Care Plan?                               How do I use my Care Plan?
set of defined benefits that ensure all medical
scheme members have access to certain             The 25 chronic conditions all have a set of        The Care Plan has a list of the applicable
minimum health services. The aim is to            services that are applicable to their diagnosis,   ICD-10 codes (diagnosis codes), tariff codes
provide people with continuous care to            treatment and management. These typically          (service description codes) and the allowable
improve their health and well-being, and to       include doctors' consultations, blood tests        number of services for each of these tariff
make healthcare more affordable.                  and other investigations that are applicable       codes. Remember to present a copy of your
                                                  to the various conditions. These services are      Care Plan during your next visit to the doctor.
                                                  then paid directly from the PMB benefit and        The doctor will render the relevant services,
 What are the 25 chronic                          not from the savings or day-                                       i.e. consultations or blood
 conditions covered under the                     to day benefits. The funds                                         tests, and submit the claim to
 PMBs?                                            available in the members'                                          be paid from the PMB benefit.

    Addison's Disease
                                                  savings or day-to-day benefits
                                                  can then last longer during
                                                                                     The aim is to                   Please note it is important that
    Asthma                                        the year. Members on the         provide people                    the correct ICD-10 and tariff
    Bipolar Mood Disorder                         Private Network Core                                               codes are used on the claim to
    Bronchiectasis                                benefit plan do not have a       with continuous                   ensure that the claim is paid
    Cardiac Dysrhythmia                           savings benefit and must
                                                  therefore make use of their
                                                                                   care to improve                   from the correct benefit.
    Cardiac Failure/Cardiomyopathy
    Chronic Obstructive Pulmonary Disease         Care Plans appropriately.        their health and                  How do I obtain a
                                                  The PMB Care Plan provides       well-being, and                   PMB Care Plan?
    Chronic Renal Disease
    Coronary Artery Disease                       management for your
                                                  condition for the entire year
                                                                                       to make                       Care Plans were posted to all
                                                                                                                     qualifying members in February
    Crohn's Disease
    Diabetes Insipidus
                                                  and must therefore be used       healthcare more                   2010. Members had to confirm
                                                  appropriately and prudently.
    Diabetes Mellitus Type I                      Care Plans were posted to           affordable.                    diagnosis of one of the 25 PMB
                                                                                                                     conditions listed to qualify for
    Diabetes Mellitus Type II                     all qualifying members in                                          a Care Plan.
    Epilepsy                                      February 2010.
    Glaucoma                                                                                         Members that register their chronic
                                                  Why should I use my Care Plan                      medication for the PMB conditions with the
    Hyperlipidaemia                                                                                  Chronic Medicine Programme will
    Hypertension                                  and what is the benefit?                           automatically have a Care Plan generated
    Hypothyroidism                                The usage of the Care Plan will ensure that        and posted to them.
    Multiple Sclerosis                            you receive optimal management of your
    Parkinson's Disease                           chronic condition. You will be able to go for      Should you wish to contact the Consolidated
    Rheumatoid Arthritis                          regular doctor consultations and have the          Disease Management Department for the
    Schizophrenia                                 applicable tests performed to monitor and          generation of a Care Plan (provided that you
    Systemic Lupus Erythematosus (SLE)            manage your condition. Using a Care Plan           have one of the PMB conditions and qualify
    Ulcerative Colitis                            appropriately will result in the services being    for a Care Plan), please call 0800 225 151
                                                  paid from the correct benefit                      for one of the consultants to assist you.

   Please note: Always consult with your doctor before starting any exercise programme.

   Below are some simple exercises you can start with.

   Cardiovascular exercises:

                                   Resistance exercises:                                                                                                                                                                                                                                  Calves: standing
                                                                                                                                                                                                                                                                                          calf raises
                                                                                                                                                                                                                                                                                             This exercise can be
                                                                                                                                                                                                                                                                                             done on the edges of
                                                                                                                                                                                                                                                                                             stairs, wood blocks,
                                                                                                                                                                                                                                                                                             books, etc.
                                                                                                                                                                                                                                                  Triceps: bench dips                        Do both legs at the same
                                                                                                                                                                                                                                                                                             time to start with then,
                                                                                                                                                                                                                                                    These can be done on the edge            as you get stronger, do
                                                                                                                                                                                                                                                    of a chair or bench.                     them one leg at a time.
                                                                                                                                                                                                                                                    Sit on the side edge of a flat           Hold a bag in your hand
                                                                                                                                                                                                                                                    bench or the front edge of a chair.      for resistance as you get
                                                                                                                                                                                                                                                    Place your hands on the edge of          stronger.
Chest: wall push-ups                                                                                                                                                                                                                                the chair right beside your glutes       Stand on the edge of the
  Stand facing a wall with your                                                                                                                                                                                                                     and grip the edge.                       block with only the balls
                                                                                                                                                                                                               Biceps: curls                        To start with, your feet should
  feet about 1 to 2 feet back                                                                                                                                                                                                                                                                of your feet on the block.
  from it.                                                                                                                                                                                                       Stand with your knees slightly     be flat on the floor about two           Keeping knees stiff and
  Place your hands on the wall                                                                                                                                     Abdominals: crunches                          bent, arms at your sides,          feet in front of you with your           bending only at the
                                                                                                                                                                                                                 holding your resistance bags       knees bent.                              ankles, lower your heels
  just outside shoulder-width       Back: standing rows                           Shoulders: presses             Legs: squats                                        Lie down flat on your back with your                                           Move yourself off the chair so
  apart.                                                                                                                                                             knees bent and your feet on the floor.      or two dumbbells in your                                                    down towards the floor.
  Bending only at the elbows,            Loop a towel around a vertical             Use something around           Place your feet about shoulder width apart.                                                   hands.                             you are now supporting yourself          Go down until you feel
                                                                                                                                                                     Hold your hands wherever you feel                                              on your hands.
  lower yourself forward                 pole, column or another fixed              the house for weight, e.g.     Keeping your torso vertical and a slight                                                      The curl movement happens                                                   a strong stretch in your
                                                                                                                                                                     comfortable (on your chest or beside                                           Bend your arms, dipping your
  towards the wall then push             object so that the ends of the             soup cans or milk jugs         arch in your lower back, start the                                                            only at the elbow. With your                                                calves.
                                                                                                                                                                     your head - just be sure you do not                                            body down. Go down only as far
  yourself away from it.                 towel are pointing towards you             with water in them.            movement by bending the knees.                                                                upper arm pinned at your side                                               Reverse the direction
                                                                                                                                                                     pull on your head).                                                            as you feel comfortable, being
  Keep your body stiff and               and the towel is wrapped around            From a seated or standing      Go only as far down as you feel comfortable                                                   and bending only at the elbow,                                              without bouncing and
                                                                                                                                                                     The typical crunch is taught by                                                careful not to bounce out of the
  straight during the                    the far side of the pole.                  position, hold the weights     when first starting out. If you can go down                                                   lift the weight up to shoulder                                              push up as high as you
                                                                                                                                                                     instructing you to simply roll your                                            bottom.
  movement.                              Have your feet close up to the             just above your shoulders.     until your thighs are just below parallel, do                                                 level.                                                                      can.
                                                                                                                                                                     upper torso forward. This is fine to                                           Push back up, squeezing the
                                         pole and lean back gripping on             Push them up overhead          so. This is the full range goal.                                                              Your palm should be facing                                                  Do this movement
                                                                                                                                                                     start with.                                                                    triceps.
                                         the ends of the towel and keep             slowly.                        Using leg power, push yourself back up to                                                     forward all the way up and all                                              slowly to feel the
                                                                                                                                                                     To increase the effectiveness of the                                           It is important to keep your back
                                         your body stiff and straight.                                             the start position. Use your grip on the                                                      the way down.                                                               contraction all the way
                                                                                                                                                                     crunch movement, push your chest                                               close to the edge of the bench
                                         Row yourself up with both arms.                                           bar only for balance unless you absolutely                                                    Squeeze hard at the top then                                                up.
                                                                                                                                                                     and head up towards the ceiling pushing                                        as you do these to minimize
                                         Keep your back arched and row                                             need to pull yourself up.                                                                     lower slowly.
                                                                                                                                                                     your lower back flat onto the floor.                                           shoulder stress.
                                         with your back.                                                           For weight, use two duffel bags (evenly                                                       Do the same with the other                                               SOURCE :
                                                                                                                                                                     Hold at the top of the movement for                                            When you have done the set,
                                                                                                                   loaded) or two milk jugs, etc. Hold them                                                      arm, alternating back and                                                Accessed in November 2009
                                                                                                                                                                     a second and squeeze hard.                                                     push yourself back onto the chair.
                                                                                                                   at your sides and squat.                                                                      forth.                                                         

                                                                              8                                                                                                                                                             9
Please note: Always consult with your doctor       cleansing diet can make you feel tired
before beginning any diet programme.               and could interfere with certain
                                                   activities, such as driving. Remember
A detox diet (also called a cleansing diet) will   to switch off all telephones, fax
remove toxins and poisons from your body.          machines and the television, and to
The idea of a good detox diet is to eat pure       block out irritating stimuli that
and natural foods that will aid the function       could detract from your
of the lymph, kidneys and liver.                   relaxation.

By detoxing you are, in effect, rebuilding and     Rule 2:
strengthening your detoxifying organs, which
should then help you gain more energy, clear
your skin, improve digestion and strengthen        Drink only liquids
your immune system against infections or           (no solids) if you
illness.                                           can stomach this
                                                   type of regimen and
The liver is our most effective cleansing          only do this for two                                                                       fibre to
organ. It receives 2.268 litres of blood per       days. Clean water,                                                                        clean out
minute but when our body is overloaded             spring water, diluted fruit                                                             the bowel.
with junk, it is the first to be affected.         juices, fresh fruit and                                                               Foods that
                                                   vegetable juices whipped up in                                                      are the best
Skin, the body's largest organ, plays an           a food processor and iced rooibos                                                 sources of
important role in detoxing by sweating out         tea with lemon and honey, are all excellent                                     dietary fibre
urea and other waste products. It is also a        liquids that will detoxify the body. A high-                                  include fresh, raw,
barometer of health and the first area to          liquid intake helps to flush out the liver,                                 unpeeled fruits and
show signs of improvement.                         kidneys and bowel.                                                        vegetables; dried fruit;
                                                                                                                          whole-wheat bread; high-
                                                   Do not overdo your liquid intake; stick to                          bran cereal; oats; brown rice;
You know it's time to detox                        having about three litres of liquid a day for                    whole-wheat crackers and snack
when you suffer from:                              your two-day detox. Drinking too much               breads. Soak dried fruit in boiling water
                                                   liquid can be harmful, so only detox for two        overnight and then boil in the same liquid
                                                   days, not longer. Once you have completed           until soft. Add one to two tablespoons of
    dizziness, fatigue, light headedness, sugar
                                                   your detox, go back to drinking 2.5 litres of       honey to this. Add fruit and liquid to oatmeal
                                                   liquid a day (this includes all liquids, not just   porridge for a delicious breakfast rich in fibre.
    frequent mood changes such as
    depression, forgetfulness and lack of          water), so that you do not dilute your
    concentration                                  electrolytes.                                       Rule 4: Vitamin and mineral
    bloatedness, nausea, poor digestion,
                                                   Fruit cocktail:
    constipation or irregular bowel activity
    intolerance towards fatty foods and                                                                When you take time out for a day or two
                                                   Wash and cut up any combination of the
    alcohol                                                                                            to allow your body to heal itself, remember
                                                   following fruits:
    excessive sweating and unpleasant body                                                             to continue with your vitamin and mineral
    odour                                                                                              supplements.
    worsening or onset of hay fever, asthma             sweet melon (spanspek)
    or skin rashes                                      pawpaw                                         Rule 5: Important
    raised blood pressure or fluid retention.           grapes                                         considerations
Many people want to detox, but are not sure             peaches                                        The basic cleansing diet should not be used
where to begin. In this article we show you             plums                                          for longer than two days. Do not use this
how to do this, using a basic cleansing diet.           guavas.                                        diet if you suffer from any illness, or have
Just keep in mind that it is better to do it                                                           problems such as heart disease, diabetes,
over a weekend or during a holiday as the          Remember to remove all pips and to use              low blood sugar, kidney problems or any
diet, although very good for you, can make         seedless grapes. Process the fruit together         other serious condition. Do not exert yourself
you feel a bit faint or tired. This cleansing      with one to two tablespoons of honey. Drink         while using the diet and therefore all
diet should also not be followed for more          immediately. Add ice cubes or crushed ice.          strenuous activities, such as exercise and
than two to three days and those on it should      Do not store for long periods, not even in          working, are taboo. Avoid all stimulants such
never take any laxatives or herbal products        the fridge, as vitamin C is easily destroyed        as alcohol, Ceylon tea, coffee, cola drinks,
that could interfere with their bowel or           by exposure to light and air. Add carrot or         carbonated cold drinks, chocolate, cocoa
kidney function. A basic cleansing diet should     beetroot to boost beta-carotene and                 and cigarettes.
make you feel a lot better and give your body      bioflavonoid content.
a chance to rest from overindulging.                                                                   SOURCES:
                                                                                                         Accessed in December 2009
                                                   Rule 3: Dietary fibre                       
Rule 1: Rest                                                                                             Weight_Centre/15-51-85,15716.asp
                                                   If you feel that you need more than liquids
If you are going to clean out your system          to sustain you during the cleansing period,             Accessed in December 2009
take a day or two off and rest, because the        concentrate on eating foods rich in dietary   

Spot the Difference
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Circle the differences that you find.
                                                                        Junior Spot the Difference competition,
                                                                        PO Box 32759, Braamfontein 2017.
                                                                        Your entry form must reach Transmed by no later than
                                                                        8 April 2010.
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                                                                        POSTAL ADDRESS:

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   Melanoma                                                             Post your answers to:
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   Cardiovascular                                                       PO Box 32759, Braamfontein 2017.
   Resolution                                                           Your entry form must reach Transmed by no later than
                                                                        8 April 2010.
                                                                        FULL NAME:
   Smart                                                                PHYSICAL ADDRESS:

   Diet                                                                 POSTAL ADDRESS:

                                                                        E-MAIL ADDRESS:
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 The words may be spelt either horizontically, vertically, forwards,    TEL: (H)
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