HR Challenge #2: How do I build an effective employee health benefits plan?

HR Challenge #2: How do I build an effective employee health benefits plan?

The goals for your effective employee health benefits plan should focus on measurable, health-specific factors that will align with your business goals. It’s important to take a balanced approach and consider the different variables that will ultimately add up to a successful plan.

Some key questions to start off:
• Do you want to improve overall employee health?
• Do you want to use health benefits as a retention or recruitment advantage?
• Do you want to address a specific benefits challenge?

We have worked with one of our clients to focus on a 3-pronged approach:
Better health
Better savings
Better engagement

With this approach, our client was able to improve employee healthy lifestyle choices and health outcomes with reduced risks and costs in their employee population. Their customised programme allowed employees to participate in preventive programmes to take better control of their health.

Talk to MHC today to find out more about our MHC Employee Health Benefits programme which covers both GP and SP services to telemedicine, in-house clinics, flexible benefits and wellness programmes.

To book an appointment with our MHC consultant, kindly email sales@MHCAsiaGroup.com.

HR Challenge #1: How do I manage growing healthcare costs?

Human resources leaders have been facing various challenges after challenges these past few years. This year is no different in terms of helping to shape the company.

Employee well-being remains among the top HR issues this year. After the major pandemic disruptions, companies begin to realise the need for customized employee health benefit plans to address individual employees’ requirements. Companies are offering better, more varied benefits, including telehealth, and expanding coverage to mental health services.

In these coming weeks, we will be bringing you a series of HR Challenges and how some of our clients have addressed them, in hope that it can also help you find a resolution.

HR Challenge #1: How do I manage growing healthcare costs?

This is a rising concern among companies and HR departments. There are many solutions around this such as tiered programmes, enhancing employee’s well-being, introducing tele-medicine, etc.

One solution that one of our MHC clients adopted was to look into a preventive care programme which included on-site health screening and an on-site health clinic. Other preventive care offerings can also be introduced such as wellness programmes, incentives for participation in health screenings or low-cost vaccination programmes that can help prevent acute illnesses.

Find out more about our MHC Programme today and how our extensive network of Panel Clinics can help you manage against today’s rising healthcare costs. With our comprehensive network credentialing process, rest assured that this cost containment comes along with appropriate care, striking the best balance between managing costs and providing comprehensive employee benefit coverage.

Find out more about our MHC Programme’s corporate health benefits can help your company today.

To book an appointment with our MHC consultant, kindly email sales@MHCAsiaGroup.com.

Does Chronic Obstructive Pulmonary Disease (COPD) lead to Lung Cancer?

Does Chronic Obstructive Pulmonary Disease (COPD) lead to Lung Cancer? 

The development of Chronic Obstructive Pulmonary Disease (COPD) as well as Lung Cancer is primarily influenced by smoking. For us to make a distinction between the two as well as to understand how these are related to one another, we need to define COPD.

What is COPD?

COPD is a condition in which the damage to lung tissue reduces the elastic recoil of the lungs, causing shortness of breath. COPD occurs in the setting of emphysema and chronic bronchitis. Long-term exposure to airborne irritants like cigarette smoke and air pollutants leads to lung damage (Emphysema) and the superadded infections result in further lung damage and morbidity (Chronic Bronchitis). As a result, the airways and air sacs of the lungs lose their elasticity (ability to expand and shrink back), the walls of the air sacs may get thickened and the airways may produce more mucus than normal which can clog the airways and thus ‘obstruct’ the passage of air. Almost all cases of COPD are caused by tobacco smoking.

Is COPD related to the development of Lung Cancer?

COPD is indirectly related to the development of Lung Cancer in the sense that the precursors for the development of both conditions are primarily cigarette smoke and airborne irritants. Patients with COPD are at a higher risk of developing Lung cancer than those who don’t have COPD. COPD directly sets the stage for the development of lung cancer by damaging the cells of the lungs and placing greater stress on the repair mechanisms often to the point of exhaustion. This can lead to damage to the DNA of the cells. Such damaged cells may divide indefinitely and result in the development of lung cancer (Uncontrolled division of cells).

COPD is caused by a variety of environmental and genetic factors. According to an article published in BioMed research international 2019, Cigarette smoke increases capillary fluid leakage and inflammation in lung tissue. This leads to increased EMT (Epithelial-Mesenchymal Transition) and EndMT (Endothelial-Mesenchymal Transition) which increases the risk for tumorigenesis (development of cancer). The direct cell damage and repair in the setting of chronic inflammation also increases the risk of the development of lung cancer.

According to a pooled global study conducted at Harvard T.H. Chan School of Public Health; “Compared with non-COPD subjects, smoking behaviours showed a significantly higher effect on SCLC risk among COPD subjects, and further, COPD patients showed a 1.86-fold higher risk of SCLC.” Thus, COPD shows a direct causal pathway for the development of Small Cell Lung Carcinoma and warrants further research on the given topic.

The Difference between the Symptoms of COPD and Lung Cancer

While many of the symptoms of both COPD and Lung Cancer are similar such as shortness of breath, coughing, wheezing and chest tightness, there are certain key alarm features that clinically distinguish Lung Cancer from COPD. These are;

● Anorexia and cachexia (extreme weight loss and wasting of body). This weight loss is unexplained having no fathomable cause.
● Coughing up blood (Hemoptysis)
● Tiredness and Chronic fatigue
● Chest pain
● Loss of appetite
● Hoarseness of voice
● A chronic cough that gets worse and does not go away

Preventive Measures for COPD

The best preventions against COPD are;
● Cessation of smoking or should not start smoking in the first place.
● Reduction of exposure to airborne noxious stimuli. This may be done in a variety of ways like wearing face masks. etc.
● Reducing the exposure to Second-Hand Smoke (smoke from the burning end of a cigarette or the smoke inhaled from the smoking by another person).
● Getting counselling or joining support groups to help quit smoking. Using products that help wean you off smoking.
● Pulmonary rehabilitation.
● Maintaining a healthy lifestyle and having an exercise routine. A study in the American Journal of Respiratory and Critical Care Medicine indicated that physical exercise protects against the development of COPD as well as its progression.
● Early detection of COPD by chest X-ray (hyperinflated lungs, tubular heart and decreased vascular markings) and PFT (Pulmonary Function Testing).
● Breathing Exercises and Chest Physiotherapy.
● Taking occupational precautions in case of high exposure to smoke.
● Coordinated community research and awareness for better management of COPD and Lung Cancer at the level of the community.
● Annual flu vaccination and pneumococcal vaccination to help prevent respiratory infections and chronic bronchitis.

In short, COPD is one of the most prevalent respiratory illnesses (2.3% of the Singaporean population has COPD) and awareness and appropriate prevention can reduce significant morbidity and mortality thus improving quality of life.

References

1) https://www.sciencedirect.com/science/article/pii/S235239641530147X
2) Hou, W., Hu, S., Li, C., Ma, H., Wang, Q., Meng, G., Guo, T., & Zhang, J. (2019). Cigarette Smoke Induced Lung Barrier Dysfunction, EMT, and Tissue Remodeling: A Possible Link between COPD and Lung Cancer. BioMed research international, 2019, 2025636. https://doi.org/10.1155/2019/2025636
3) https://www.cdc.gov/cancer/lung/basic_info/symptoms.htm
4) Garcia-Aymerich, J., Lange, P., Benet, M., Schnohr, P., & Antó, J. M. (2007). Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: a population-based cohort study. American journal of respiratory and critical care medicine, 175(5), 458–463. https://doi.org/10.1164/rccm.200607-896OC

#1 for the Best Health Screening Centre

Level 15 of MHC Medical Centre (Amara)

#1 for the Best Health Screening Centre   

MHC Asia Group is honoured to be one of the Best Health Screening Centre featured by BestinSingapore and MoreBetter Singapore.

Our newly opened flagship medical centre is located in the middle of Singapore’s bustling city, consisting of 2 spacious floors at Level 14 & 15 dedicated to both corporates and individuals’ healthcare needs.

A one-stop health & wellness centre, newly renovated with numerous consult rooms, lounge areas and state of the art health screening facilities to provide a relaxing and comfortable health check experience.

The 15th floor of MHC’s flagship medical centre, MHC Prestige, is equipped with an exclusive customer lounge, large pantry with a wide selection of coffee and tea, VIP lounge, VIP pods, Imaging Centre as well as a treadmill room to cater for all your health requirements – allowing you to experience a more private and exclusive health check journey with us.

MHC also has a wide variety of health screening packages available from personal to prestige packages, each designed to detect the most common diseases and conditions based on your gender and age group and, we are passionate about your health and well-being in order to optimise your health outcomes.

Click below to view our feature!

 

Level 14 of MHC Medical Centre (Amara)
Level 15 of MHC Medical Centre (Amara)

Health Connect – March 2023 Edition

Health Connect – March 2023

Anaemia happens when one has insufficient red blood cells and/or has red blood cells that are not functioning properly. It is characterized by low haemoglobin levels. This is important because red blood cells and haemoglobin assist in transporting oxygen around the body to allow the tissues to function properly.

Patients who suffer from anaemia can present with a variety of symptoms that affect many body systems such as fatigue, breathlessness, chest discomfort, dizziness, palpitations, cold hands, reduced effort tolerance etc. There are also those who do not have symptoms.

The incidence of anaemia in the community also has socio-economic impacts as it affects productivity, physical capacity, health outcomes and more.
 
Broadly speaking, anaemia can be largely categorized into the following causes:
●    Anaemia due to blood loss 
This happens when there is blood loss from the body. For example, through the gastrointestinal/respiratory/urinary tracts (e.g. cancers, inflammatory disease) or through the reproductive system (e.g. heavy menses, intermenstrual bleeding).
●    Anaemia due to inadequate/defective cell production
This can be due to nutritional deficiencies (e.g. Vitamin B12/Folate/Iron), inherited conditions, bone marrow disorders, kidney/chronic diseases etc.
●    Anaemia due to increased cell destruction
 This can be due to autoimmune conditions, drugs, infections, inherited conditions etc.

The treatment of anaemia is dependent on the underlying cause. The first step is to always ensure that the patient is clinically stable. The subsequent work-up is very important as well to determine the treatment plan. The investigations of choice depend greatly on the patient’s history, comorbidities, risk factors and clinical findings. 
 
Disclaimer: All content in this publication is for informational and educational purposes only. It does not constitute any form of medical advice or clinical care nor is it intended to be a substitute for professional medical care. Please speak to your healthcare provider if you have any questions pertaining to your healthcare.

 

Anxiety Disorders

Anxiety Disorders

The stigma surrounding mental health disorders may sometimes prevent individuals who need mental healthcare from seeking it out1.

There is an increasing prevalence in anxiety disorders in Singapore2 and those who suffer from it can present with a variety of symptoms3. Common symptoms include, but not limited to, nervousness, restlessness, sense of impending doom, rapid heart rate, palpitations, chest discomfort, rapid breathing, sweating, trembling, troubles with concentration, gastrointestinal issues, sleep disturbances, neurological complaints and more.

Anxiety disorders can be significantly debilitating and detrimental to those who suffer from it, and it can affect one’s daily activities including school/job performance, social lives and relationships with others.

There are multiple types of anxiety disorders and it can affect children, adolescents and adults. These include generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, specific phobias etc.

Here is a brief explanation of the types of anxieties4.

Generalised anxiety disorder – You feel excessive, unrealistic worries and tension with little or no reason.

Panic disorder – You feel sudden, intense fear that brings on a panic attack. During a panic attack you may break out in sweat, have chest pains, and have a pounding heartbeat (palpitations). Sometimes you may feel like you’re choking or having a heart attack.

Social anxiety disorder – Also called social phobia, this is when you feel overwhelming worry and self-consciousness about everyday social situations. You obsessively worry about others judging you or being embarrassed or ridiculed.

Specific phobias – You feel intense fear of a specific object or situation, such as heights or flying. The fear goes beyond what’s appropriate and may cause you to avoid ordinary situations.

Agoraphobia – You have an intense fear of being in a place where it seems hard to escape or get help if an emergency occurs. For example, you may panic or feel anxious when on an aeroplane, public transportation, or standing in line with a crowd. 

There are also some medical conditions that can cause the aforementioned symptoms, which may necessitate further investigations. E.g. thyrotoxicosis.

The diagnosis of the anxiety disorder will be made by your healthcare provider. The management of anxiety disorders is dependent on the disease type and several other factors like severity, comorbidities and more. It can include psychotherapy and medications and this will be decided by your healthcare provider.

Mental health and wellness are of fundamental importance to an individual’s well-being and early intervention is key.

_________________________

[1] https://www.psychiatry.org/patients-families/stigma-and-discrimination

[2] https://www.imh.com.sg/Newsroom/News-Releases/Documents/SMHS%202016_Media%20Release_FINAL_web%20upload.pdf

[3] https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961

[4] https://www.webmd.com/anxiety-panic/guide/anxiety-disorders

Health Connect – February 2023 Edition

Health Connect – February Edition 2023

We hope that everyone has been staying safe over the festive season!

In this month’s newsletter, we have decided to do something a little different in the spirit of the new year.

Here are 10 interesting medical facts that may be of interest to you:
1. The average adult human has 206 bones
2. The largest bone is called the femur (in the thigh)
3. The body’s largest organ is the skin
4. The Scottie Dog sign, named after the Scottie Dog, is a radiological sign in X-Ray imaging
5. The Hot Cross Bun sign, named after the popular snack, is a sign described in MRI imaging of the brain in certain diseases
6. A fetus’ urine contributes to the amniotic fluid in the womb
7. Breast cancer can affect males too
8. The human heart has 4 different chambers
9. In dextrocardia, the heart is situated on the right side of the body
10. Opposable thumbs play an important role in our ability to grip things

We hope that you have been enjoying these monthly newsletters and do let us know if you have any other medical topics that you wish to read about.

Thank you for all your support and we are happy to be your partner in your healthcare journey.

Prostate Cancer: What Singaporean Men Should Know

Prostate Cancer: What Singaporean Men Should Know

About a thousand Singaporean men died of prostate cancer from 2015 to 2019. This makes this illness an important issue in men’s health. The prostate is a small gland found just below the bladder in males. It wraps around the tube, called the urethra, through which urine passes from the bladder to the penis. It produces some of the fluid that forms part of semen. It tends to grow as a man ages, constricting the urethra and decreasing the flow of urine. Sometimes, its cells can grow out of control, and that is when prostate cancer occurs.

Prostate cancer statistics
Prostate cancer was the second most prevalent cancer in men in Singapore from 2015 to 2019. 5,875 men had it diagnosed, accounting about 15.4% of all cancers found. It came in second only to rectum and colon cancers in men, which accounted for 16.9% of all cancer cases. By 2020, prostate cancer was third at 15.1%. 

Male Chinese and Indians had prostate cancer at a rate that ranked second among all ethnic groups while it ranked fourth among Malays.
It was the most prevalent type of cancer among people aged 70 to 79 and the second most common cancer among men in Singapore between the ages of 50 and 69. At 80 years of age and beyond, it was the third most common cancer in men after cancers of the lung and cancers of the colon and rectum. It was not one of the common cancers that affected men younger than 50 years old.

Prostate cancer was the fourth most common cancer-related cause of death in Singapore for men during 2015 to 2019. There were 989 such deaths, contributing 6.3% to the total. On a positive note, there is a high rate of avoiding prostate cancer death within 5 years.

Symptoms of Prostate Cancer
Remember that the prostate gland wraps around the urethra, and a growing cancer narrows the passages for urine. So, trouble urinating or a decrease in the force of urine’s flow may be warning signs of prostate cancer. Pain during urination and an increase in the frequency of needing to urinate are also symptoms of prostate cancer. The cancer in the prostate may cause some bleeding, and that may show up as blood in the urine or semen. It is also possible for the cancer to cause problems with a man’s capability to have and maintain an erection.

Like other cancers, prostate cancer can cause weight loss. If the cancer spreads to other parts of the body, it can cause problems in the areas affected. For example, it can cause pain once it spreads into the bones, causing pain in the back, hips, or other affected bony areas.

All these symptoms depend on the kind of cancer present in the prostate. Most of the time, prostate cancer grows slowly and remains confined to the gland. In these cases, it takes several years before the problems become noticeable. In the early part of these cases, symptoms may not be present. In other cases, the cancer is aggressive and can spread quickly.

In any case, seek medical care if you experience the symptoms mentioned. The earlier you visit a men’s health clinic, the earlier you might have the problem diagnosed, and the better the chances of treatment become.

Causes of Prostate Cancer
Although the exact causes of this illness are unknown, there are known risk factors. Age, being 50 years old and above, is the greatest risk factor. As mentioned, Chinese are more likely to have it compared with Indians and Malays. Having a blood relative who had prostate cancer or a family member with genes that increase breast cancer risk both make you more likely to develop prostate cancer.

Lifestyle and diet also matter to men’s wellness in terms of prostate cancer risk. Smoking and a diet rich in fat while being low on fibre both increase the risks.

High testosterone levels increase the risk. Sexual activity does not.

Prostate cancer screening and prevention
Because not all cases can have symptoms, you should visit the medical clinic for your men’s health check up. Have a men’s health screening for prostate cancer if you have symptoms or if you are 50 years old or above. You can ask for earlier screening if you have risks from your family history.

There are no specific means of prevention as there are no specific causes to target. At best, you should strive to remain healthy, avoid smoking, and eat a healthy diet. Watch out for the symptoms, now that you are armed with knowledge, and have yourself screened if necessary.

References
1. Centers for Disease Control and Prevention. Prostate Cancer. https://www.cdc.gov/cancer/prostate/basic_info/what-is-prostate-cancer.htm. Last reviewed 25 Aug 2022.
2. Singapore Cancer Registry, Health Promotion Board. Singapore Cancer Registry Annual Report 2019. National Registry of Diseases Office.
3. International Agency for Research on Cancer. Cancer Today. https://gco.iarc.fr/today/online-analysis-pie?v=2020&mode=cancer&mode_population=continents&population=900&populations=702&key=total&sex=1&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&nb_items=7&group_cancer=1&include_nmsc=1&include_nmsc_other=1&half_pie=0&donut=0.
4. Mayo Clinic. Prostate Cancer. https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087. 2022.
5. SingHealth. Prostate Cancer. https://www.singhealth.com.sg/patient-care/conditions-treatments/prostate-cancer. 2021.
6. Singapore Cancer Society. Prostate Cancer. https://www.singaporecancersociety.org.sg/learn-about-cancer/types-of-cancer/prostate-cancer.html#risk-factors. 2016.

HIV/ AIDS – What you Need to Know

HIV_AIDS

HIV / AIDS – What you NEED to Know 

With the prevalence of 9,129 cases of HIV by the end of 2021, the incidence of 171 new cases among Singaporean residents was reported between January and October 2022 by the Ministry of Health on Thursday (Dec 01), 2022. A need for further awareness and screening is the need of the hour.

What is HIV / AIDS?

HIV (Human Immunodeficiency Virus) is the virus that weakens the natural defences of the body by targeting the CD4+ T-Cells (a type of white blood cell) responsible for the immunity while utilising the dying cell as a hotbed of its replication and growth. This entire process culminates in AIDS (Acquired Immunodeficiency Syndrome), a medical condition characterised by an increased susceptibility to a host of otherwise less common infections.

It is important to recognise that it is not the virus itself that results in the syndrome but the lack of immunity it produces and the resultant infections and their complications which cause significant morbidity and mortality. These infections include tuberculosis, herpes simplex (shingles), candidiasis (fungal infection), CMV (cytomegalovirus) infection, bacterial pneumonia, and Kaposi sarcoma to name a few.

How does HIV spread?

The main causes of the spread of HIV are;

  • Unprotected Sexual Intercourse – The major cause of HIV spread is unprotected intercourse with an HIV-positive person. The risk of transmission of HIV is significantly higher for receptive anal intercourse (1:100) compared to receptive vaginal intercourse (1:1000) and insertive vaginal intercourse (1:3000-1:10,000).
  • Needle Stick Injury – Injection drug use with sharing of contaminated needles or accidental pricks of infected Needles and sharps is another major cause of the spread of HIV (1:300). This is a predominant risk for IV drug abusers and healthcare providers.
  • From Infected mother to baby – Vertical transmission from mother to baby significantly contributes to the spread of HIV.
  • Oral Sex – Receptive fellatio with ejaculation is also a major cause. The statistics about insertive oral sex, however, are unclear.
  • Blood Transfusion – Extremely rare since the advent of screening practices prior to transfusion.
  • Tattooing and Body Piercing – Rarely occurs when done so without proper hygiene (when instruments have infected blood on them).

HIV generally does not spread by;

  • Through saliva (kissing), tears and sweat.
  • Sharing toilets.
  • Sexual activities not involving the transfer of body fluids (touching. etc).
  • Sharing utensils.
  • Coughing or sneezing.

How can HIV / AIDS be prevented?

In light of broad clinical literature and the guidelines provided by the Ministry of Health, Singapore, the following measures are deemed most effective to help prevent HIV and AIDS:

  • Protected sexual intercourse using physical barriers such as effective use of Condoms.
  • Regular screening for high-risk groups (those engaged in casual sex or with commercial sex workers).
  • Screening tests for spouses before engaging in unprotected sex.
  • Remaining faithful to one’s partner.
  • Avoid sharing needles for IV drug injections.
  • Pre-Exposure prophylaxis with medications (anti-retroviral therapy) for engaging in sexual contact with an infected partner.
  • Post-Exposure prophylaxis after a possible HIV exposure. This must be started within 72 hours of the exposure after consulting with your healthcare provider.
  • HIV in pregnancy – Mandatory screening in pregnancy. Start HIV treatment as soon as possible (even in the first trimester) if tested positive and continue throughout pregnancy to decrease the viral load. This should be followed up by intrapartum (during parturition) injection of anti-retroviral therapy to prevent transmission from the mother to the baby.
  • Prevention for the baby of an HIV-positive mother – The baby should also receive zidovudine (HIV medication) during delivery and 6 weeks following delivery to prevent transmission.
  • Elective Caesarean delivery for HIV-positive women having high viral load (>1000/µl) at the time of delivery.
  • HIV screening at home (confidential) – Anonymous HIV testing at home has recently been made available to the public by certain healthcare providers.

What if I test positive?

If you test positive for HIV, you will be put on antiretroviral medications by your healthcare provider as early as possible provided the indications for antiretroviral therapy which are;

  • A CD4+ T-Cell count below 500/µl.
  • A high viral load. (>100,000/µl).
  • Presence of opportunistic or superadded infections.

Viral resistance testing (genotyping) will be performed before starting antiretroviral therapy. The response to therapy is mostly measured by CD4+ cell count and Viral load (PCR-RNA level)

It is important to note that the early detection of HIV (mostly a result of self-indicated screening) leads to a better prognosis since starting antiretroviral therapy (HIV medication) at an early stage has significant success in reducing viral loads and the life expectancy of an HIV -positive person with the viral load as low as negligible matches that of an HIV-negative person.

 

References

For Incidence and Prevalence in Singapore:

https://www.moh.gov.sg/news-highlights/details/update-on-hiv-aids-situation-in-singapore-2022-(december-2022)#:~:text=A%20total%20of%20171%20newly,the%20same%20period%20in%202021.

For Medical knowledge, Mechanism, Treatment and prevention:

  • Harrison’s Principles of Internal Medicine, 20th Edition
  • Davidson’s Principles and Practice of Internal Medicine, 24th Edition
  • Mastering the Boards by Conrad Fischer, 4th
  • https://www.cdc.gov/

Health Connect – January 2023 Edition

Health Connect – January Edition 

Carpal Tunnel Syndrome (CTS), a condition that we see commonly in the community, is due to the compression of the median nerve as it travels through the carpal tunnel at the wrist due to anatomic compression and/or inflammation (1). CTS is also associated with other risk factors like one’s comorbidities (e.g. diabetes mellitus, thyroid disease) and the environment (e.g. occupation)(2).

Patients who suffer from CTS report a variety of symptoms depending on the severity of disease. Common symptoms include, but are not limited to, pain, numbness, weakness and tingling in the outer 3.5 fingers. CTS can be diagnosed clinically but further diagnostic investigations like nerve conduction studies/electromyography and imaging are commonly performed as well.

The management of CTS is tailored to the individual. It includes medications, activity modification, wrist splinting and management of the comorbidities. Surgery is also sometimes performed for some patients. Do speak to your healthcare provider for further information regarding this.

References

  1. https://www.uptodate.com/contents/carpal-tunnel-syndrome-pathophysiology-and-risk-factors
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048004/

Disclaimer: All content in this publication is for informational and educational purposes only. It does not constitute any form of medical advice or clinical care nor is it intended to be a substitute for professional medical care. Please speak to your healthcare provider if you have any questions pertaining to your healthcare.