Update from Dr. Aw

Emotional resilience and bouncing back from adversity

Top 10 tips

How do we develop our emotional resilience?

Studies have looked at the emotional response to failure as a factor that can help improve resilience. High emotional resilience was associated with higher self-esteem, positive attributional style (optimistic view) and lower sense of perfectionism. Perfectionism can fuel a sense of always being too hard on yourself and setting unrealistic expectations in a complex changing world. It’s OK — and liberating — to not be perfect!

Emotional resilience is also linked to having a clear sense of purpose and meaning in your life. The Japanese have a saying called “IKIGAI” which is daily reminder of one’s reason for being and why we get out of bed in the morning. A clear sense of purpose can fuel optimism!

Learn from these tips

I encourage you to check out the tips the American Psychological Association posted on 10 Ways to Build Resilience:

1. Make connections.

2. Avoid seeing crises as insurmountable problems.

3. Accept that change is a part of living.

4. Move toward your goals.

5. Take decisive actions.

6. Look for opportunities for self-discovery.

7. Nurture a positive view of yourself.

8. Keep things in perspective.

9. Maintain a hopeful outlook.

10. Take care of yourself.

Emotional resilience is a personal journey and iterative process of trying, failing, adapting and evolving. Life’s experiences — happy and sad — teach us how to cope with adversity in our own personal way. Winston Churchill famously said, “Success is not final, failure is not fatal: It is the courage to continue that counts.”

References

1. Fredrickson BL. The Broaden-and-Build theory of positive emotions. Philos Trans R Soc Lond B Biol Sci. 2004;359(1449):1367-1378. doi:10.1098/rstb.2004.1512PubMedGoogleOpens new windowScholarCrossref

2. Masten AS. Ordinary magic: resilience processes in development. Am Psychol. 2001;56(3):227-238. doi:10.1037/0003-066X.56.3.227PubMedGoogleOpens new window ScholarCrossref

3. Exploration of Individual and System-Level Well-being Initiatives at an Academic Surgical Residency Program A Mixed-Methods Study https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774645?utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamanetworkopen&utm_content=wklyforyou&utm_term=010621Opens new window

4. Personal and work-related factors associated with nurse resilience: A systematic review https://pubmed.ncbi.nlm.nih.gov/30925279/Opens new window

5. Resilience to emotional distress in response to failure, error or mistakes: A systematic review https://www.sciencedirect.com/science/article/abs/pii/S0272735816302902?via%3DihubOpens new window

6. American Psychology Association. Resilience curing the COVID-19 Pandemic. 10 Ways to Build Resilience. https://performanceandlearning.ca/blogpost/1880447/355945/Resilience-During-the-COVID-19-PandemicOpens new window

7. Resilience Guide for Parents and Teachers. http://www.turners.act.edu.au/__data/assets/pdf_file/0006/353166/APA_Resilience_Guide_for_parents_and_teachers.pdfOpens new window

8. Emotional Resilience Self Assessment https://positivepsychology.com/emotional-resilience/Opens new window

There is a patient in my practice that always makes me laugh. He is a grey-haired, retired businessman and proud grandfather who always delivers self-deprecating, one-line zingers with a dead pan face and raised eyebrow during our visits. He reminds me of the late comedian Rodney Dangerfield, who based his act on never getting any respect! Dangerfield would say one-liners like, “My wife was afraid of the dark… then she saw me naked and now she’s afraid of the light!”

Humour connects us as human beings. Dr. Hunter “Patch” Adams was a physician, comedian and clown who incorporated laughter as therapy for patients and founded the Gesundheit! Institute in 1971. You may know him from when the late actor, and comedian, Robin Williams portrayed Dr. Patch Adams in a 1998 movie. Patch Adams brings humour to orphans, patients and caregivers around the world through volunteers that dress as clowns and practice laugh therapy.

There are many known health benefits from laughter:

• Laughter releases endorphins and serotonin neurochemicals which make you feel good

• Laughter strengthens social bonds, improves mood, emotional resiliency and stimulates brain connectivity.

• Laughter is good for the heart: it’s an anti-inflammatory, lowers blood pressure and improves glucose tolerance 

• Laughter is good for the immune system, decreases stress hormones and may help relieve pain.

​​​​​​​​​​​​​​Laughter is medicine!​​​​​​​​​​​​​​

Laughter in the office

Laughter is also becoming a competitive advantage in the workplace. Stanford University now offers a course called “Humor: Serious Business.” Laughter improves engagement, wellbeing and fosters creativity and collaboration in the workplace.

Some of the findings from Stanford professors, Aaker and Bagdonas, include:

• Leaders with a sense of humour are seen as 27% more motivating and admired. Their employees are 15% more engaged and their teams are more than twice as likely to solve a creativity challenge.

• When pairs of strangers laughed together for five minutes before completing an exercise, their interactions were 30% more intimate than the control condition.

• Workplaces that embedded humour in their culture said employees were 16% more likely to stay at their jobs, feel engaged and experience satisfaction.

​​​​​​​Studies during the pandemic are showing that workers miss socializing in the office and can feel disconnected if working remotely. We miss the casual collisions in the office that help to foster spontaneous shared moments of laughter and humour.

Laughter and Kids

Children seem to smile easily. It is almost impossible to not smile when you hear a child giggling and belly laughing. “Mirror neurons” are important in early child development as babies start to mimic facial and emotional responses to sensory stimuli. Smiling and laughter also activate mirror neurons in adults. Smiles and belly laughs are contagious!

Research has shown that children laugh about 400 times a day – while adults only laugh about 15 times a day. Daily laughter seems to decrease in the 20s and increases again over the age of 70! I never really thought about doing a daily laughter audit – but I guess it would be strange if I didn’t laugh once during any given day?

Your Laughter Prescription

MCET, (Motion Creates Emotion Theory) is based on the concept that the body doesn’t know the difference between intentionally laughing and spontaneous laughter. Both are good for you! Some academics have suggested a more scientific approach to prescribing laughter. Even the physical act of laughing can have positive psychological and physiological benefits. There are different types of Laugh Theories, which include:

• genuine (“spontaneous”)

• self-induced (“simulated”)

• stimulated (e.g. tickling)

• induced (i.e. drugs)

• pathological (disorders of emotional expression due to brain damage).

There are other examples of prescriptive laugher:

• Laughter Yoga developed in India is a form of self-induced or forced laughter group therapy.

• One well designed study in Japan found that ‘laughter with exercise’ sessions in individuals over the age of 60 found led to an increase in self-rated health, improvement in bone density and improved blood sugars (decrease in HbA1C).

• To combat loneliness, humanoid robots made in Japan and Hong Kong can recognize human emotion and may become companions for the lonely (particularly the elderly).

Laughter and humor are important for happiness and wellbeing. It is healthy to have a sense of humour and be open to moments of laughter. Give yourself permission to laugh at yourself. Don’t take yourself too seriously. Levity is a great mindset.

Ask yourself, “What has made you laugh recently?” and “How often do you laugh?” Find time in your life for regular doses of laughter and humour. As reggae legend Bob Marley once said, “Love, friendship, laughter… some of the best things in life really are free.”

References

1. Rodney Dangerfield Brainy Quote https://www.brainyquote.com/authors/rodney-dangerfield-quotesOpens new window

2. Patch Adams. Wikipedia. https://en.wikipedia.org/wiki/Patch_AdamsOpens new window

3. Humor, Seriously. Jennifer Aaker and Naomi Bagdonas. https://www.humorseriously.com/Opens new window

4. Humor may be the surprising key to rebuilding trust—and reconnecting with coworkers again. Fortune 2021. https://fortune.com/2021/03/31/reconnect-coworkers-humor-slack/Opens new window; https://fortune.com/2021/03/31/smile-humor-may-be-whats-been-missing-at-work/Opens new window

5. Healing Power of Laughter https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609137/Opens new window

6. The Laughter Prescription The Laughter Prescription (nih.gov)Opens new window

7. Hirosaki M, Ohira T, Kajiura M, et al. Effects of a laughter and exercise program on physiological and psychological health among community-dwelling elderly in Japan: randomized controlled trial. Geriatr Gerontol Int. 2013;13:152-160. [PubMedOpens new window] [Google ScholarOpens new window]

8. Stress relief from laughter? It's no joke - Mayo ClinicOpens new window

9. Laughter-inducing therapies: Systematic review and meta-analysis - ScienceDirectOpens new window

10. AI beats human at making you laugh https://hbswk.hbs.edu/item/it-s-no-joke-ai-beats-humans-at-making-you-laughOpens new window

11. Teaching robots to laugh. https://www.scientificamerican.com/article/scientists-are-teaching-robots-to-laugh/Opens new window

12. Ex Machina film https://en.wikipedia.org/wiki/Ex_Machina_(film)​​​​​​​Opens new window
    
    

Emotional resilience and bouncing back from adversity ​​​​​​​

Dealing with this pandemic has been a marathon on our physical, mental and emotional well-being. I’ve been listening to patients and colleagues in my medical practice go through a rollercoaster of ups and downs dealing with the uncertainty, anxiety, stress, COVID burnout.

As a physician, sometimes it feels like I’m supposed to have all the answers. But we are all struggling with our well-being. In fact, amid the pandemic, an American and Scandinavian study was done on surgical residents. It found that there were significant barriers in the profession to using well-being resources, but there are ways to introduce tools. Key components of an effective and holistic well-being program provided training in:

• emotional (mindfulness-based affective) regulation skills

• advance scheduling of time off

• attention to work quality (vs. quantity)

• ability to address inefficient systems in a psychologically safe workplace

We must check in with ourselves, be kind to ourselves and recognize what we need to get through this difficult time. Hey, we’re all human. We’ll have good days and bad days, grumpy days and happy days — and that’s okay.

As we collectively shift our focus on trying to adapt to living with the virus, resilience is an important topic.

Take action — Here are a few resources to help you address your emotional resilience.

Learn from these tips:

I encourage you to check out the tips the American Psychological Association posted on 10 Ways to Build ResilienceOpens new window:

1. Make connections.

2. Avoid seeing crises as insurmountable problems.

3. Accept that change is a part of living.

4. Move toward your goals.

5. Take decisive actions.

6. Look for opportunities for self-discovery.

7. Nurture a positive view of yourself.

8. Keep things in perspective.

9. Maintain a hopeful outlook.

10. Take care of yourself.

Personalize your wellness:

You may benefit from taking your own wellbeing measurement to assess your current emotional health. Check out these:

1. Maslach Burnout Inventory Self-TestOpens new window

2. Cohen Perceived Stress Scale (measure of stress for men and women aged 18-34)Opens new window

3. Patient Health Questionnaire (depression screening tool)Opens new window

4. Alcohol Use Disorders Identification Test (World Health Organization)Opens new window

5. Spielberger State-Anxiety Index (subjective feelings, arousal correlated to anxiety to trauma)Opens new window

6. Cognitive Affective Mindfulness Scale [attention to one’s thoughts, feelings and sensations), present focus, open awareness, acceptance]Opens new window

7. Mental Health Continuum-Short Form (individual social, emotional and psychological well-being)Opens new window

8. Demand Control Support Questionnaire (job strain for psychological demand, control, social support)Opens new window

Emotional resilience is a personal journey and iterative process of trying, failing, adapting and evolving.  Life’s experiences  — happy and sad — teach us how to cope with adversity in our own personal way.  Winston Churchill famously said, “Success is not final, failure is not fatal: It is the courage to continue that counts.”

References

1. Fredrickson  BL.  The Broaden-and-Build theory of positive emotions. Philos Trans R Soc Lond B Biol Sci. 2004;359(1449):1367-1378. doi: 10.1098/rstb.2004.1512PubMedGoogle ScholarCrossrefOpens new window

2. Masten  AS.  Ordinary magic: resilience processes in development. Am Psychol. 2001;56(3):227-238. doi: 10.1037/0003-066X.56.3.227PubMedGoogle ScholarCrossrefOpens new window

3. Exploration of Individual and System-Level Well-being Initiatives at an Academic Surgical Residency Program A Mixed-Methods Study https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774645?utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamanetworkopen&utm_content=wklyforyou&utm_term=010621Opens new window

4. Personal and work-related factors associated with nurse resilience: A systematic review https://pubmed.ncbi.nlm.nih.gov/30925279/Opens new window

5. Resilience to emotional distress in response to failure, error or mistakes: A systematic review https://www.sciencedirect.com/science/article/abs/pii/S0272735816302902?via%3DihubOpens new window

6. American Psychology Association.  Resilience curing the COVID-19 Pandemic. 10 Ways to Build Resilience. https://performanceandlearning.ca/blogpost/1880447/355945/Resilience-During-the-COVID-19-PandemicOpens new window

7. Resilience Guide for Parents and Teachers. http://www.turners.act.edu.au/__data/assets/pdf_file/0006/353166/APA_Resilience_Guide_for_parents_and_teachers.pdfOpens new window

8. Emotional Resilience Self Assessment https://positivepsychology.com/emotional-resilience/Opens new window

As we celebrate Valentine’s Day this month, we are all reminded of the ones we love, or perhaps a chance to flirt and show our romantic side to someone special. It is curious how powerful emotions, (happy or sad), can deeply affect how we physically feel in the moment. That visceral warm and tingling feeling when experiencing an act of love and kindness or that horrible wrenching chest and gut feeling when someone has “broken your heart”. There is a medical condition called Takotsubo stress cardiomyopathy where you could even die of a broken heart. An intense emotional or stressful event leads to a nervous system response that releases neurochemicals (catecholamines) causing spasm of your heart muscles and swelling in one of your chambers leading to temporary heart failure. On x-ray the heart muscle looks like a Japanese container used to trap octopus (hence named Takotsubo!). There is a higher prevalence of underlying anxiety and depression in these patients, but fortunately, this condition is rare and reversible with supportive treatment.

I have always been fascinated by the Heart Brain Connection. Heart and stroke disease (cardiovascular disease) can accelerate cognitive decline and be a risk factor for dementia. Cardiovascular disease in middle age can be a predictor of future brain functioning decline. The Maastricht Aging Study (MAAS) was a famous 12-year follow up study of cognitively healthy individuals (age 24-82, n=1823) who underwent extensive executive function testing (memory, information processing speed) and found cognitive impairment was more frequent in those with cardiovascular disease. Interestingly – the stronger associations were among younger individuals with risk factors who developed progressive cognitive impairment rather than later in life.

Shared risk factors and mechanistic pathways likely explain the heart brain connection. Several studies have shown the association of midlife high blood pressure, diabetes and low physical activity with lower cognitive functioning. It seems that the accumulation of multiple risk factors over the life course worsens the risk of brain decline as opposed to a single factor. The shared biological mechanisms are also likely a combination of a predisposition to chronic inflammation, clotting, strokes, lower heart function (output) and arrhythmias (like atrial fibrillation).

The heart-brain connection: common risk factors and mechanistic links over the life course.

Source:   Eur Heart J, Volume 38, Issue 43, 14 November 2017, Pages 3229–3231, https://doi.org/10.1093/eurheartj/ehx387Opens new window

So how do we keep a healthy heart brain connection?

It is important to stay informed (health literacy) on modifiable risk factors and master “self-efficacy” of daily dietary, physical and emotional healthy behaviours. It is always good to assess your “Heart Age”. The CDC has a nice online tool based on the Framingham Study of risk stratification.
(https://www.cdc.gov/vitalsigns/heartage/index.htmlOpens new window)

It is also critical to continue any prescribed medications (i.e. statins for lipids, anti-blood pressure pills, diabetic medications, etc.) and check in regularly with your health care provider to avoid delays in testing or treatment. The pandemic has taught us about the importance of societal and behavioural factors on prevention. COVID-19 has led to a significant drop in cardiovascular testing globally and delays in diagnosis and care for preventable diseases. The lack of compliance with universal mask wearing has led to COVID-19 infections which are now known to be associated with cardiovascular, neurological disease and “brain fog” in long hauler patients (long COVID). Simply wearing a mask during a pandemic may protect your heart and brain!

Ultimately - a more holistic approach will be helpful to preserve a healthy heart-brain connection versus an oversimplified disease centric approach (i.e. healthcare in silos). It is important to focus on your emotional and brain health to protect your heart.

Here are five daily lifestyle practices to reduce stress and improve neurochemical responses from cardiologist Dr. Michael Miller who is the author of “Heal your Heart, The Positive Emotions Prescription to Prevent and Reverse Heart Disease”:

1. Meditation (serotonin activated relaxation practices)

2. Yoga (GABA induced mood stabilization)

3. Laughter (endorphin mediated visual effects)

4. Music (dopamine regulated auditory effects

5. Massages, hugging (oxytocin activated tactile responses)

Albert Einstein once said, “Don’t let your brain interfere with your heart.” The heart and brain are interlinked as much as humans are to each other. Your brain health affects your heart health and vice versa. During this pandemic, remember to take daily breaks and recharge. Humans were never meant to sit in front of a screen for all hours of the day. Unplug and give yourself permission to take some timeouts. So - for this Valentine’s Day month – give someone (pets count here too!) a hug or share some laughs and music with loved ones. These simple daily acts are great for the heart brain connection and is just what the doctor ordered!

References

1. Tako-tsubo cardiopathy (Broken Heart) https://www.sciencedirect.com/science/article/pii/S2213158219304711?via%3Dihub;Opens new window https://www.internationaljournalofcardiology.com/article/S0167-5273(16)34540-5/fulltextOpens new window

2. Whitehall studies https://academic.oup.com/ije/article/34/2/251/746997Opens new window

3. The Heart Brain Connection https://academic.oup.com/eurheartj/article/38/43/3229/3980157Opens new window

4. INTERHEART STUDY https://pubmed.ncbi.nlm.nih.gov/15364185/Opens new window

5. ​​​​​​​International impact of COVID-19 on the diagnosis of heart disease https://www.jacc.org/doi/10.1016/j.jacc.2020.10.054Opens new window

6. Emotional Rescue: The Heart-Brain Connection https://pubmed.ncbi.nlm.nih.gov/32206169/Opens new window
   

Dr. Aw Answers More Employee Questions about COVID-19

February 5, 2021

We caught up with Dr. Aw to get answers to more employee questions about COVID-19. (Answers provided January 8, 2020)

Multi-part question:

• What do we need to know about vaccines?

• Are they safe?

• How quickly can those of us who are lower risk expect to get the vaccine?

• Can you transmit the virus after you are vaccinated?

• When will we reach herd immunity?

Will the vaccine work on the new strain?

Is there anything I can do to mitigate the impact of the virus?

What role does winter and cold weather play in transmission?

What does it mean if a virus becomes endemic?

Will things get better in 2021?

How Physical Activity Drives Energy

January 8, 2021

Join the conversation with Dr. Aw and Brendan Fox to learn how important it is to cultivate energy, and create a daily routine for yourself. If you are watching I encourage you to join along!

I saw a patient recently who for this article, we will name “Sam.” Sam is a middle-aged man working in finance who has gained 10-15 “pandemic” pounds and his midsection is expanding. He confessed that he is an emotional eater, has a weakness for cookies and late-night snacks during times of stress. Sam is working from home and putting in long days as his workload has increased. He hasn’t been working out and hasn’t yet figured out how to replace the visits to the gym with home exercises. He was experiencing low energy and getting some recurring non-COVID infections (sore throats, fungal rashes). He was feeling stiff from sitting at the computer all day and getting some funny chest pains. Sam checked out his blood pressure at a local pharmacy and was told that he was borderline high. He booked an appointment with me for a checkup.

I ran some tests. His ECG was normal – but his blood pressure (BP) was slightly elevated at 140/90. His blood work was “borderline” abnormal (slightly out of the normal range). His blood sugar was elevated (but not in the diabetic range). His triglycerides (a type of lipid/fat in the blood) were elevated and his HDL (“good cholesterol”; high density lipoprotein) was low. His waist circumference was above average (over 40 cm). Sam had a bunch of little things that when we put them together are classified as “Pre-Diabetes” also known as Metabolic syndrome, Syndrome X, Insulin Resistance, Obesity Dyslipidemia Syndrome and the “deadly quartet”. His future risk of developing diabetes, heart disease and stroke is much higher unless he can convert those “borderline” abnormal results – back into the normal category.

So back to Sam….

I saw Sam at a follow-up appointment, and he looked fantastic!  He lost 10 lbs. by adopting the Mediterranean Diet, decreasing his daily salt intake, and cutting out the cookies and late-night snacks.  He also started doing daily walks and worked out virtually with a personal trainer a few times a week.  We discussed some of the new Canadian 24 hour movement guidelines (https://csepguidelines.ca/Opens new window) that emphasizes the importance of limiting screen time and increasing daily activity with time protected for sleep.  His home blood pressure readings were now around 120/80.  We repeated his blood work and his glucose, HDL and triglycerides were trending better.  Best of all – he felt great and energized!

The American National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria define metabolic syndrome as the presence of any three of the following five traits:

• Abdominal obesity, defined as a waist circumference ≥102 cm (40 in) in men and ≥88 cm (35 in) in women

• Serum triglycerides ≥150 mg/dL (1.7 mmol/L) or drug treatment for elevated triglycerides

• Serum high-density lipoprotein (HDL) cholesterol <40 mg/dL (1 mmol/L) in men and <50 mg/dL (1.3 mmol/L) in women or drug treatment for low HDL cholesterol

• Blood pressure ≥130/85 mmHg or drug treatment for elevated blood pressure

• Fasting plasma glucose (FPG) ≥100 mg/dL (5.6 mmol/L) or drug treatment for elevated blood glucose

Source: https://www.nhlbi.nih.gov/files/docs/guidelines/atglance.pdfOpens new window

Metabolic syndrome (pre-diabetes) has also been associated with several obesity-related medical conditions such as fatty liver, cirrhosis and liver cancer, chronic kidney disease, polycystic ovarian disease, sleep apnea and high uric acid (gout).  Metabolic syndrome has also been linked to chronic inflammation and risk for cognitive decline and dementia.  High blood pressure, lipid levels (cholesterol, triglycerides) and diabetes are a very bad combination for several diseases!

References

1. Metabolic Syndrome https://medlineplus.gov/metabolicsyndrome.htmlOpens new window 

2.  Frederick Banting and the Discovery of Insulin  https://definingmomentscanada.ca/news/officially-launched-insulin100-inspiration-and-innovation/Opens new window 

3. Mediterranean Diet https://medlineplus.gov/ency/patientinstructions/000110.htm#:~:text=The%20Mediterranean%20diet%20is%20based%20on%3A%201%20Plant-based,and%20seasoned%20simply%2C%20without%20sauces%20and%20gravies.%20Opens new window 

4. Glycemic Index https://medlineplus.gov/ency/patientinstructions/000941.htmOpens new window 

5. DASH Diet  https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/dash-diet/art-20048456Opens new window 

6. The Metabolic Pandemic https://www.ahajournals.org/doi/full/10.1161/ATVBAHA.107.151092Opens new window 

7. Global Prevalence  https://emedicine.medscape.com/article/165124-overview#a6Opens new window 

8. Canadian 24 hour movement guidelines https://csepguidelines.ca/wp-content/uploads/2020/10/24HMovementGuidelines-Adults18-64-2020-ENG.pdfOpens new window 

Dr. Aw Answers Employee Questions about COVID-19

December 9, 2020

As the pandemic continues to evolve, OMERS employees posed some topical questions to our Chief Medical Officer, Dr James Aw about the current state and what to expect as we look to a new year. (Answers provided November 20, 2020)

How long do I need to be near someone to be at risk?

Will there be a third wave?

What's happening with vaccines and treatments?

How long will the pandemic last?

Wellness seems easy to understand – but difficult to master. There are many definitions of wellness and our life journeys are unique to each of us. Wellness is personal. The healthiest individuals that I have met over the years in my clinical practice, personal and business life all seem to take a holistic view to wellbeing and don’t take anything for granted. Achieving wellness requires a lot of work, discipline and positive daily habits. It’s not simply excelling in one thing (i.e. physical, mental, financial, job satisfaction, relationships, etc.) - but mastery of many things at the same time.

I have found a few helpful frameworks that address the multiple dimensions of wellbeing. Traditionally – medicine has been more reactive and focused on diagnosing and treating physical and mental health. However – prevention of disease and feeling well requires a broader perspective. One of my medical heroes is Sir William Osler who was a Canadian physician who graduated from McGill University and one of the founders of Johns Hopkins School of Medicine in Baltimore, USA. One of his quotes has always stuck with me. “The good physician treats the disease. The great physician treats the person who has the disease.”

Preventive health strategies recognize that physical and mental health are intimately intertwined with social elements such as interpersonal relationships, community service, occupational satisfaction and financial independence. Social connectiveness, meaning in life and how we feel have huge impacts on our overall wellbeing.

I propose that you create your own Wellness Checklist that you can refer to daily. How would you honestly evaluate yourself in each of the wellness dimensions? How many A’s and B’s versus C’s and D’s would show up on your Wellness Report Card? Wellness is more than how many pushups you can do or feeling good about yourself. What is going well and where do you need more attention? The point of evaluating your wellness areas is to increase personal awareness and not creating additional stress. It is not a competition. It is about being your best whole self.

Start where you are at. Set goals and create an action plan in each Wellness area. Keep it simple and actionable with a positive outcome. SMART goal setting is a common approach used for decades which believes that goals should be Specific, Measurable, Actionable, Realistic and have a Timeline. Starting your day in the right mindset and kickstarted with physical activity (something that makes you sweat!) can have huge benefits. I recently read Robin Sharma’s book called “The 5 am Club” which focuses on the power of morning healthy habits.

I have written previously on the challenges of behaviour change (Change Wheel). If change was easy – we wouldn’t keep talking about it. Judith Hibbard from the University of Oregon is well known for her research on patient activation which acknowledges the individual’s role in behaviour change. Individuals require knowledge, confidence and skills to manage their own health and ultimately lead to positive outcomes. Individuals with high levels of activation feel empowered – whereby others with low activation have a more passive approach and less likely to seek help. Try to assess your own level of activation in the different Wellness spheres and seek help, guidance and inspiration in the areas that need some attention.

Source: https://www.england.nhs.uk/wp-content/uploads/2018/04/patient-activation-measure-quick-guide.pdfOpens new window

In summary – wellness starts with awareness (personal health audit, checklist) and requires action (goal setting, activation) to improve outcomes. Wellness is social. We need each other for support, guidance and inspiration. Have a growth mindset – so that wellness becomes a personal journey of exploration and new experiences. It should be fun and meaningful to be sustainable.

Be a lifelong learner and become an expert on you!

References

1. Sir William Osler https://en.wikipedia.org/wiki/William_OslerOpens new window

2. Atul Gawande http://atulgawande.com/book/the-checklist-manifesto/Opens new window

3. Robin Sharma https://booksummaryclub.com/5-am-club-summary/Opens new window

4. SMART goals. Doran, G. T. (1981). "There's a S.M.A.R.T. Way to Write Management's Goals and Objectives", Management Review, Vol. 70, Issue 11, pp. 35-36.

5. Behaviour Change. https://omers.sharepoint.com/sites/Pulse/SitePages/Wellness/Dr-Aw-Behaviour-Change.aspxOpens new window

6. Judith Hibbard. Patient Activation. https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/supporting-people-manage-health-patient-activation-may14.pdfOpens new window

​​​​​​​Over the summer – I picked up a book called “The Healthy Indoors: The Surprising Science of How Buildings Shape our Behavior, Health and Happiness” by Emily Anthes.  Anthes is a science writer who claimed that modern humans are an indoor species who (pre-COVID) spend 90% of our time shuffling between homes, offices, schools, stores, restaurants and gyms.  She looked at how indoor spaces affect our mental and physical well-being as well as our emotions, productivity and even relationships.  It was an interesting read considering our current pandemic times where most of us are working from home and avoiding crowds where there is prolonged indoor exposure. 

The new COVID normal has highlighted the importance of indoor air exchange and flow, disinfection protocols and health and safety protocols for buildings where we work and play.  Oxford Properties has been a leader in building design and real estate investment with projects around the world.  I decided to sit down with Dean Hopkins, Chief Operating Officer, Oxford Properties and Claire McIntyre, Head of Brand, Marketing and Communications, Oxford Properties to get their viewpoints on the Future of Healthy Buildings.

Before I get to Dean and Claire – let me share some of the insights that I picked up from Anthes’ book.

Anthes reviewed the research and future trends on “smart” buildings, adaptive and amphibious architecture, biophilic buildings and urban design for mentally healthy cities (links below).  She cited examples of established Green building certification programs (LEED – Leadership in Energy and Environmental Design, Living Building Challenge) and progressive environmentally friendly designs such as the Seattle Bullitt Center and the Powerhouse in Scandinavia.  Other healthy building certification programs include WELL and Fitwel.

Academic institutions such as the Mayo Clinic Well Living Lab and Harvard Healthy Building Program have innovation research labs that are focused on the future of wellness, indoor health and building design.  “Smart” buildings will be able to enhance real time monitoring of VOCs (volatile organic compounds), CO2 (carbon dioxide) ventilation rates, particulates and a host of other environmental conditions in the office.  Organizations such as the Centre for Urban Design and Mental Health in London, Happy City in Vancouver, First Place Autism in Arizona and Tiger Place for the Elderly in Missouri are examples of research focused on the design of cities that address mental health.

Nature is also important in future wellness designs.  Biophilic design is built around the concept that humans have an understandable affinity with the natural world.  A Finnish company called Naava has designed “living” green walls with plants for clean air and the California Earth Institute promotes the use of earth and sandbags to create eco-friendly Super Adobe Dome living and working structures.  New York-based COOKFOX Architects have a mission of designing buildings that foster the well-being of people and a healthy urban landscape. Oxford is working with COOKFOX to create St. John’s Terminal, an adaptive reuse project on the west side of Manhattan that has been fully pre-leased to Google. Amphibious architecture are flexible structures that are built around water.   

The London School of Economics published a paper on the use of a checklist to measure the impact of built environments on well-being.   The SALIENT checklist stands for Sound, Air, Light, Image, Ergonomics, Nature and Tint.  The aim was to link behavioural science to how built environments affect what we do and how we feel. 

What is the Future of the Indoors and Wellness during and post COVID?

Dean feels that healthy buildings will become a competitive advantage for tenants. Best buildings will provide healthy experiences for users.  Everything from touch free experience to real time data sharing of environmental conditions powered by technology.  Sensors will automate cleaning protocols, indoor air quality and lighting (smart windows) while optimizing the use of natural sunlight.  Common office spaces will need to be redesigned to maximize creativity and social connection while staying safe.  Buildings of the future will be designed to enhance the emotional wellbeing of occupants.  People need to feel psychologically safe and inspired in their indoor spaces.  He hopes to create a Living Lab at Oxford to pilot innovative designs.

Claire feels that there will be a focus on understanding and measuring the health impact of various interventions that physical space can deliver and quantifying what customers truly value.  Behavioural data science will help inform building design and investment decisions and pair with smart technology to create adaptable buildings for different communities and populations. The future of the workplace will also be influenced by the type of work and links to productivity.  Office spaces that foster collaboration, problem solving, and professional growth will increasingly be the focal point for the best companies, especially in a hybrid world where some employees work partly from home. Buildings will evolve from a customer service focus to an experience mindset.  Claire also feels that there will be a trend of increasing transparency (data scorecards, rankings) between building owners and customers.  The leading companies will figure out how to incorporate a holistic approach to wellness in their buildings.

There are many exciting innovations to create healthy buildings of the future. The pandemic has accelerated the pace of change and adoption of these concepts that focus on the human experience.  We all look forward to enjoying a healthier indoors!

Influenza Update – Get your Flu Shot!

Friday, October 23, 2020

It’s the time of the year to get a flu shot. However – this year is different because of the COVID-19 global pandemic.

On the positive side – the public health measures of physical distancing, masking, avoiding crowds and washing hands have led to a decrease in global influenza cases, (particularly in the southern hemisphere), because COVID-19 and influenza are transmitted the same way. But - the northern hemisphere is starting the influenza season during the fall and winter months. WHO (World Health Organization) FLU NET and the Global Influenza Surveillance and Response System monitor influenzaOpens new window cases in real time. The good news is that there is an influenza vaccine whose composition is updated annually based on circulating strains. Research is also underway to review the association of influenza vaccination and severity of COVID-19 disease (i.e. could the flu shot help decrease COVID transmission through some cross reacting immune protective effects?). Meanwhile, the scientific community is working around the clock to develop a COVID-19 vaccine, improve point of care testing options and treatments. Hopefully medical breakthroughs will be coming at the end of 2020 and into 2021. Stay tuned!

On the negative side – the symptoms of COVID-19 and influenza are very similar, (links below), and may place additional strains on local healthcare systems and the economy. Both viruses are easily transmissible and can spread before the onset of symptoms. The system may not be able to handle a “twin-demic” surge of testing requirements, hospitalizations and high levels of worker and school absenteeism. Thus – this year it is very important for everyone to get their flu shot since influenza is preventable!

Here’s a quick primer on influenza and its role in past pandemics:

It is estimated that influenza vaccines are up to 70% effective (~ 50-60% for strains A, 70% for B) depending on the year’s strain. No vaccine is perfect. Therefore – it is very important to practice the usual precautions to limit the transmission of respiratory diseases including COVID-19 and influenza:

• Wear a mask

• Wash your hands frequently

• Avoid crowds

• Outdoors is better than indoors to limit transmission

• Physically distance. If you can’t avoid close contact with people, then wear a mask

• Cough and sneeze into a tissue or your sleeve and not your hands

• If you are sick with symptoms of the flu or any respiratory virus – stay home and check in with a healthcare provider.

Simple behaviours can make a huge difference and limit transmission of infectious diseases. Let’s work together so we can all stay safe!

Source: https://www.hopkinsmedicine.org/Health/Conditions-and-Diseases/Coronavirus/Flu-Prevention-And-Coronavirus-InfographicOpens new window

References
1. Flu vs. COVID symptoms. CDC https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htmOpens new window; WHO https://www.who.int/westernpacific/news/q-a-detail/q-a-similarities-and-differences-covid-19-and-influenza;Opens new window Johns Hopkins https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-fluOpens new window; Mayo https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-vs-flu/art-20490339Opens new window
2. Flu Shots. Ontario Flu Facts https://www.ontario.ca/page/flu-factsOpens new window; CDC Flu Shots https://www.cdc.gov/flu/prevent/keyfacts.htmOpens new window
3. WHO Flu Net and Global Influenza Surveillance and Response System https://www.who.int/influenza/gisrs_laboratory/flunet/en/Opens new window
4. WHO Seasonal influenza https://www.who.int/en/news-room/fact-sheets/detail/influenza-(seasonal)Opens new window5. Medscape – Influenza Review https://emedicine.medscape.com/article/219557-overview#a6Opens new window6. Johns Hopkins COVID Map https://coronavirus.jhu.edu/map.htmlOpens new window

During my early days at OMERS – I was warmly welcomed by colleagues Anne Soh, VP of Actuarial Services and Plan Actuary and Lisa Conway, Director of Growth Equity, who spoke to me about their exciting community work with Canada’s National Ballet School, who was doing some interesting work with Baycrest, a global leader in brain health and aging. Anne and Lisa were both very passionate about a wonderful program run by the school called “Sharing Dance Seniors.” In response to the pandemic, they shifted the program online and offered several free events providing instruction on dance and movement virtually. The broader National Ballet of Canada also offered virtual ballet lessons to front line health care workers at a hospital in Toronto. What great wellness initiatives!

Physical benefits of dancing include improved aerobic power, muscle endurance, strength, flexibility, gait (balance), bone density and reduced risk of falls and cardiovascular disease (1). This program also allows participants a healthy outlet for creativity, artistic expression and belonging to a community.

Studies (5) are also finding music interventions may be beneficial in movement disorders (Parkinson’s Disease, Huntington disease, Tourette syndrome, progressive supranuclear palsy). Evidence is emerging on the benefits of group dancing, singing and instrumental music performance particularly in Parkinson’s disease.

The social benefits of dance are many and include combating loneliness through human connection. Let’s also not forget the emotional importance of joy and play. There is lots of research on child play – but emerging studies are looking at the importance of adult “play time”. We all need to recharge and have fun as part of an overall wellness strategy. I found a study (6) from Carnegie Mellon University that elegantly defined play in adulthood as “a behaviour or activity that is carried out with the goal of amusement and fun, involves an enthusiastic and in-the-moment attitude or approach, and is highly interactive among play partners or with the activity itself) and identifies potential immediate outcomes (e.g. positive affect, feelings of being accepted and valued, reductions in daily stress) and long-term outcomes (e.g. psychological, physical and relational health) of play in adulthood, with an emphasis on play occurring within the context of close relationships.” Or stately simply. Sing and Dance!

I will leave you with lyrics from the 1987 song “Come from the Heart” by songwriters Susanna Clark and Richard Leigh:

“You’ve got to sing like you don’t need the money
Love like you’ll never get hurt
You’ve got to dance like nobody’s watchin’
It’s gotta come from the heart if you want it to work.”

Stay healthy!

References

1. Physical Benefits of Dancing for Healthy Older Adults. https://journals.humankinetics.com/view/journals/japa/17/4/article-p479.xmlOpens new window

2. Art for life’s sake. https://nationalpost.com/health/art-for-lifes-sake-the-health-benefits-of-cultureOpens new window

3. Engaging in Visual Arts Improves Subjective Wellbeing for Adults with mental health conditions https://www.mcmasteroptimalaging.org/full-article/es/engagement-visual-arts-improves-subjective-wellbeing-adults-mental-health-3098?hl=artOpens new window

4. Art therapy and music reminiscence activity in the prevention of cognitive decline. https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-2080-7Opens new window

5. Music therapy for Movement Disorders. https://pubmed.ncbi.nlm.nih.gov/31720865/Opens new window

6. Young at Heart. https://journals.sagepub.com/doi/10.1177/1745691615596789Opens new window

September 10 marked Suicide Prevention Day

Friday, September 18, 2020

On September 10, the World Health Organization (WHO) marked Suicide Prevention Day to raise awareness that suicide can be prevented.

Mental health is one of the toughest areas of medicine to treat and losing a patient to suicide is one of the saddest experiences for a physician. My first experiences with suicide actually involved two professional colleagues. One was a medical classmate of mine who took her life during her residency training. Our classmates were shocked, as she always seemed to be the happiest and most upbeat person. In retrospect, she was probably covering up so much pain and lack of hope despite being successful in her career path. Another incident involved a physician colleague of mine who suffered quietly from postpartum depression and tragically ended her life by jumping in front of a moving subway train with her six month-old-child. She had stopped taking her anti-depressant medications as she was worried that it would harm her child during breastfeeding. We worked together at the same clinic where she was a physician psychotherapist and we shared some patients. Again – she always seemed to have her act together, never revealed sadness or despair during interactions and was a kind and caring physician. The tragic news was shocking and a chilling reminder of the depths of despair of depression. Even physicians who are trained to identify the signs and symptoms of depression and are surrounded by health care professionals daily can feel alone and helpless. Both events still haunt me today.

COVID-19 has caused an increase in mental health cases. Early during the pandemic, the media reported about a top New York emergency physician who took her life at the age of 48 after telling her family about the psychological trauma of seeing patients die of COVID. Another tragic story affecting a frontline worker.

The CDC (Centres for Disease Control) recently published data that shows that COVID related depression is disproportionately affecting young adults (aged 18-24), certain ethnic groups (Hispanic, Black), lower educated, essential workers, unpaid caregivers for adults and those who were already being treated for previously diagnosed anxiety, depression and post traumatic disorder. Uncertainty about the future (education, employment, financial independence, social network) is particularly affecting young adults. Domestic abuse and addiction (alcohol, illicit substances) have also been troubling and increasing trends. Mental health may be worsened from fear, isolation and COVID stigmatization.

Past studies have shown increases in suicide deaths during the 1918-19 influenza pandemic and more recently among older people in Hong Kong during the 2003 severe acute respiratory syndrome (SARS) epidemic. Many studies are now emerging about the mental health pandemic from COVID-19 which will have short- and long-term psychological effects.

Suicide prevention is complex because of multiple risk factors (biological, psychological, social, environmental).

Access to timely mental health services, however, has been a challenge and more studies and real time innovation (people, process, technology) will be required to cope with COVID effects.

It is worth mentioning again the risk of the infodemic and fake news. Vulnerable persons should avoid and limit excessive exposure to negative news stories through traditional and social media. Irresponsible media reporting can also be linked to suicide risk.

It is well known that social isolation is a risk factor for mental health issues. Conversely – social connectiveness is critical for emotional health. Make sure you stay connected with people. It’s OK to not be OK during this pandemic – but you need to reach out and seek help from loved ones and health care professionals to prevent a downward spiral of hopelessness if you or a loved one are at risk. Remember - there is always hope and those willing to help.

The World Health Organization has compiled a list of risk factors for suicide and actionable steps.

Do you know someone who may be considering suicide?

What you should know if you are worried about someone

• Suicides are preventable.

• It is okay to talk about suicide.

• Asking about suicide does not provoke the act of suicide. It often reduces anxiety and helps people feel understood.
  

Warning signs that someone may be seriously thinking about suicide:

• Threatening to kill oneself.

• Saying things like "No-one will miss me when I am gone.

• " Looking for ways to kill oneself, such as seeking access to pesticides, firearms or medication, or browsing the internet for means of taking one’s own life.

• Saying goodbye to close family members and friends, giving away of valued possessions, or writing a will.
  

Who is at risk of suicide?

• People who have previously tried to take their own life.

• Someone with depression or an alcohol or drug problem.

• Those who are suffering from severe emotional distress, for example following the loss of a loved one or a relationship break-up.

• People suffering from chronic pain or illness.

• People who have experienced war, violence, trauma, abuse or discrimination.

• Those who are socially isolated.
  

What you can do?

• Find an appropriate time and a quiet place to talk about suicide with the person you are worried about. Let them know that you are there to listen.

• Encourage the person to seek help from a professional, such as a doctor, mental health professional, counsellor or social worker. Offer to accompany them to an appointment.
  If you think the person is in immediate danger, do not leave him or her alone. Seek professional help from the emergency services, a crisis line, or a health-care professional, or turn to family members.

• If the person you are worried about lives with you, ensure that he or she does not have access to means of self-harm (for example pesticides, firearms or medication) in the home.

• Stay in touch to check how the person is doing.

Remember: If you know someone who may be considering suicide, talk to them about it. Listen with an open mind and offer your support.

References

• World Health Organization https://www.who.int/mental_health/prevention/suicide/wspd/en/Opens new window

• ER DOC and suicide https://www.nbcnewyork.com/news/coronavirus/nyc-emergency-room-doctor-dies-from-suicide-after-treating-covid-19-patients/2391978/Opens new window

• CDC Mental Health trends https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htmOpens new window

• Suicide and Risk Prevention During the Pandemic. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30171-1/fulltextOpens new window

• Suicidal Behaviour in Vulnerable Populations during COVID https://academic.oup.com/qjmed/advance-article/doi/10.1093/qjmed/hcaa202/5857612Opens new window

• WHO – Do you know someone at risk for Suicide? https://www.who.int/campaigns/world-health-day/2017/handouts-depression/family/en/Opens new window

Stretches and tips to put your best foot forward

Join OMERS Chief Medical Officer Dr. Aw and fitness guru Brendan Fox as they discuss the common complaints when it comes to your knees, ankles and feet, and work through a series of movements that will help! (Why are there loons in a video about foot and knee stretches? Watch and find out!)

Our feet are the first point of contact with the world, do not forget about the health of them, follow along for:

• Practical tips that you can easily do outdoors for your feet, knees, and ankles

• All you need are your legs, and a small towel

• Common complaints in the four foot, the midfoot and hind foot from sedentary lifestyle or extra body weight - how this can lead into osteoarthrosis, certain autoimmune diseases, and gout.

Please consult with a health care provider before engaging in any new physical activities as appropriate.

Watch Conversations with Dr. Aw - Outdoor exercises for foot and ankle

Stretches for your knees

Join Brendan as he leads Dr. Aw in another set of exercises, today's focus is on knee pain.

Loosen up your tight muscles that contribute to knee pain by doing different variations to strengthen glute medius.

You will need:

• chair

• small towel

Please consult with a health care provider before engaging in any new physical activities as appropriate.

Watch Conversations with Dr. Aw - Conquering Knee Pain

Stretch it out

Fitness expert Brendan Fox leads Dr. Aw in a series of movements focusing on neck pain. Today's video will go through different postural positions that you will have to try out to get the full effect. You can work your way up to the different levels of progressions. You will need: swiss ball or a bosu ball.

Please consult with a health care provider before engaging in any new physical activities as appropriate.

Watch Conversations with Dr. Aw - Conquering Neck Pain

With the start of summer, we wondered, “Does heat impact the coronavirus?” Dr. Aw provides his perspective.

In a video Q&A, Dr. Aw provides his perspective on that topical question: Should I wear a mask?

In a video Q&A, Dr. Aw looks at the question of packages and groceries coming into your house - to disinfect or not to disinfect?

In a video filmed on May 14, Dr. Aw looks at the signs that medical and government authorities are considering as they determine their guidance.

I remember speaking with Medical Director, Johns Hopkins Sleep Disorders Center, Neurologist Dr. Charlene GamaldoOpens new window who told me once that “rest is a weapon” for optimal performance and health.  Sleep can be just as important as exercise, nutrition and stress management for physical and mental health.  Poor sleep has been associated with impairment in motivation, emotion, cognitive functions and increased risk for certain medical conditions like diabetes, cardiovascular diseases and cancer.  Most studies suggest that at least 7 hours of sleep a night is optimal – but of course there is some variability and we all know some individuals that seem to function on less sleep or require more sleep. It boils down to whether you feel rested in the morning. 

As we know - sleep routines are easily disrupted during stressful life stages at work and home, raising young children, worrying about aging parents, business travel, academic pursuits and the list goes on.  We also live in a 24/7 society and it is becoming a norm of modern life. Somehow – we manage on less sleep. Life must go on.  As Darwin said – it is not the strongest, most intelligent, but the ones that adapt that survive!

All patients with insomnia should first make sure that there is no existing medical condition that is causing sleep problems. Common causes are sleep apnea, chronic pain, psychological stress or mental health conditions (depression, anxiety, etc.).  Always consult your physician to rule out treatable causes. 

However – several patients suffer from poor sleep and don’t have an existing medical condition. ​​​​​​​

The first step is to practice good “sleep hygiene”:

1. Sleep only as much as you need to feel rested.

2. Keep a regular sleep schedule.

3. Avoid forcing sleep.

4. Exercise regularly – preferably 4-5 hours before bedtime.,

5. Avoid caffeine after lunch.

6. Avoid alcohol near bedtime.

7. Avoid smoking – particularly at night.

8. Don’t go to bed hungry.

9. Avoid prolonged use of light emitting screens before bedtime.

10. Deal with your worries before bedtime.​​​​​​​

It is best to avoid naps that are greater than 30 minutes during the day.  However – short naps (less than 30 minutes) may be beneficial for cognitive performance, alertness and mood.

Unfortunately – sleep hygiene may not be enough for some individuals. Other interventions may require engaging your personal physician or other clinicians.  Behavioural techniques include relaxation, biofeedback, stimulus control and sleep restriction. 

Relaxation therapy includes techniques such as progressively relaxing your muscles from the head down – where biofeedback may use sensors that provide you feedback to slow down breathing to release tension.  Stimulus control therapy strives to de-program patients that associate the bedroom with staying awake rather than sleeping.  Strategies may include tips such as not spending more than 20 minutes lying in bed trying to sleep and getting up to another room to read or find another relaxing activity until you feel sleepy (while avoiding activities that “reward” staying awake like eating, doing chores, watching TV, etc.).  Sleep restriction therapy involves avoiding naps and induce sleepiness by gradually decreasing the time allowed in bed per night as long as it isn’t less than five hours.

​​​​​​​Some patients benefit from cognitive therapy and/or cognitive behavioural therapy (8-10-week sessions) with a psychologist.  Phototherapy (light therapy) and chronotherapy are other techniques which try to alter the body’s “sleep clock” (circadian rhythm) by either sitting in front of a light box (30-40 minutes) or delaying sleep by 2-3 hours on successive days to make you sleep at the desired time. 

If none of these techniques work – then it may time to review the use of medications with your personal physician. However – medications is the last resort because of concerns of side effects and dependency, other treatments for insomnia have mixed evidence of benefit –
but include melatonin, acupressure, tai chi and yoga.

Sleep is complex, and one size does not fit all.  Hopefully – one of these techniques may be helpful for you.  Sweet dreams!

Resources

Johns Hopkins Medicine
https://www.hopkinsmedicine.org/health/wellness-and-prevention/sleepOpens new window

Medline Plus
https://medlineplus.gov/healthysleep.htmlOpens new window

Canadian Sleep Society
https://css-scs.ca/resources/linksOpens new window

Speaking on his first day at OMERS, Dr. Aw, a physician since 1991 and son of a federal public servant and pensioner, said that what drew him to OMERS was both its reputation as a well-run organization and the opportunity to contribute across the OMERS Community.

“This is a golden age of medicine right now in terms of innovation with genetics, genomics, big data, artificial intelligence, different health care systems, molecular medicine, immunology. There are a lot of interesting things that have an impact on the big scale, but also on the local scale. It is also the age of the internet – and with way too much information, how do you connect with people to provide them with information that is impactful in language that is easy to understand.”

Dr. Aw has been a valued and trusted source of information, insight and guidance during the current COVID-19 crisis and we look forward to sharing his thoughts with you here.

Watch Conversations With Dr. Aw