Adopting an active lifestyle is an excellent way to manage stress and encourage a sense of accomplishment, which can support mental health and well-being. Modern-day wearables offer several solutions that can help stay active while keeping track of stress levels and heart rates. In an interview with Omnia Health Insights, Prateek Kewalramani, Head of Marketing, Fitbit – MEA, Google, discusses how the personalised and actionable guidance provided by these devices can help one achieve optimum health and fitness goals.

He highlighted that Fitbit was the first to introduce an advanced health smartwatch, the Fitbit Sense, that focused on both physical and mental well-being. It brought together an innovative sensor and software technology with reportedly the world’s first electrodermal activity (EDA) sensor on a smartwatch to help manage stress, along with heart rate tracking technology, Stress Management Score, and an on-wrist skin temperature sensor.

Related: Can wearables help improve sleeping patterns?

He said: “We recently launched the Fitbit Charge 5, an advanced health and fitness tracker that also includes features like EDA technology. Also, Fitbit Premium, a paid membership in the Fitbit app, guides users to help them move more, manage stress, sleep better, and eat well. It uses data to deliver advanced insights and personalised, actionable guidance to help users achieve their health and fitness goals.”

The on-wrist EDA Scan app works by placing the palm over the face of the device to detect small electrical changes in the sweat level of the skin. Measuring EDA responses can help one understand the body’s response to stressors and help manage stress. Users can do a quick EDA Scan session on the device to see responses or pair it with guided mindfulness sessions in the app to see how the body responds during meditation or relaxation. At the end of the session, they will see an EDA response graph on-device and in the mobile app to gauge progress over time and reflect on how they feel emotionally.

Related: Stress tracking wearables: Are we there yet?

“Fitbit Sense customers are using the EDA Scan app with positive results – 70 per cent of sessions result in a lower heart rate; about 3/4 of sessions result in lower heart rate, and those who achieve higher Active Zone Minutes report lower stress,” added Kewalramani.

Prateek Kewalramani

Furthermore, Fitbit also offers the Stress Management Score on the app that calculates how the body is responding to stress based on heart rate, sleep, and activity level data. Ranging from 1-100, with a higher score indicating the body is showing fewer physical signs of stress, the score is coupled with recommendations to better manage stress, like breathing exercises and other mindfulness tools. Moreover, Fitbit Premium members get a detailed breakdown of how the score is calculated, which consists of over 10 biometric inputs, including exertion balance (impact of activity), responsiveness (heart rate, heart rate variability, and electrodermal activity from the EDA Scan app), and sleep patterns (sleep quality).

Managing stress better

When asked if wearables could act as possible mental health coaches, Kewalramani stressed that the devices are intended to help users manage their well-being and keep track of their information. They are not intended to diagnose, treat, cure, or prevent any disease.

He said: “Our goal at Fitbit is to give users more data to empower them to see changes in their fitness and well-being. Premium members can choose from more than 100 meditation sessions from popular brands like Aaptiv, Aura, Breethe, Calm, and Ten Percent Happier, listen to a variety of relaxing sounds, and see how your practice correlates with your mood over time. We took a step further by partnering with Deepak Chopra, M.D., Pioneer of Integrative Medicine, to launch Deepak Chopra’s Mindful Method, a wellness collection created and curated for members to make a mindfulness practise more accessible to people worldwide.”

Thanks to the advanced insights provided by wearables, users are able to get a better understanding of their heart health and stress. In addition, it provides insights into other key health metrics that they would have only received at the doctor’s office once or twice a year. So, they can use these insights to focus on their overall health and wellness at a time when it’s needed most.

“Wearables can help bridge the gap between visits to the doctor and facilitate conversations between patients and their providers,” Kewalramani emphasised. “Users can take a more proactive approach to their health and have informed conversations with their care teams thanks to the information that is now available on their wrists. In turn, providers and caregivers can deliver better, more personalised care, armed with actionable information about the health of their patients, further supporting them outside of the doctor’s office. We see wearables as being a complement to the healthcare system, not a replacement.”

When asked about future plans, he highlighted that Fitbit is the Official Health and Wellness Partner of the Dubai Fitness Challenge (DFC) for the third consecutive year. “We would like to call residents of Dubai to take part in DFC by dedicating 30 minutes daily to their health and well-being through exercise at home or DFC challenges and activities. Through personalised guidance, content, and insights, users can take control of their well-being and, as part of DFC, rebuild a routine that works, nurture healthier habits, and make small changes that will have longer-lasting impacts on their overall well-being,” he concluded.

EMPWR, a tech start-up dedicated to reinventing the future of wellbeing in the MENA region, has partnered with WAMDA and Microsoft for Startups to create and publish a research report focused on mental health challenges and the wellbeing of entrepreneurs.

The report is the first to collect data on the mental health and well-being of entrepreneurs in the region, with emphasis on the impact of the pandemic. According to the findings of the study, start-up founders experience higher levels of stress compared to the rest of the region, with twice the likelihood of developing depression issues. 55 per cent of start-up founders expressed that raising investment was a key reason for causing stress, followed by pandemic as the second most cited reason by 33.7 per cent of respondents.

Related: Mental health and COVID-19: How are we coping?

In addition, 35.9 per cent of founders rate the state of their mental health as ‘bad’, and 44.2 per cent spend at least two hours a week trying to de-stress. Although entrepreneurs are increasingly valuing their mental health more than ever, only 9.9 per cent rate their mental health as good. With only two per cent of healthcare budgets in the MENA region currently spent on addressing mental health, the impact of the COVID-19 pandemic on young entrepreneurs and achievers could lead to an economic burden of US$1 trillion, by 2030.

Related: How GCC governments can create resilient mental health services

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“28 per cent of the population of the Middle East is between 15 and 29 years old. Mental health issues are widespread among them but less than half are willing to seek help, due to cultural stigmas and stereotypes. Our attempt, at EMPWR, is to mainstream the conversation around the issue, so this silent epidemic, which is particularly rampant among the region’s youth and entrepreneurs, can be addressed,” says Ally Salama, founder of EMPWR.

Salama, a ‘Forbes 30 Under 30’ social entrepreneur and the Middle East's mental health ambassador, founded EMPWR, which helps provide and facilitate mental health solutions for major stakeholders in the ecosystem. Recognised by Harvard, WHO, and the United Nations for its efforts, EMPWR has advised government and corporate entities on best practices in creating safe environments where leaders of tomorrow can emerge and thrive. In an interview with Omnia Health Insights, he further discusses findings from the recent report, the mental health landscape in the region, and EMPWR’s role.

Can you comment on the research landscape in the UAE regarding mental health?

Traditionally, medical research has been lopsided in favour of physical health, at the expense of mental health. This is true across the globe. Lately, and especially since the pandemic outbreak, mental health is generating greater attention. The UAE is in sync with this global development. The government has introduced a National Policy for the Promotion of Mental Health; the University of Sharjah, Zayed University, the United Arab Emirates University and the likes have conducted several studies in recent years; and we, at EMPWR, partnered with Wamda, Microsoft and HAD Consultants for research on the impact of COVID-19 on mental health. This is to say, the research landscape on mental health is coming to life in the UAE. But I believe we have only begun to scratch the surface. Nuanced and detailed research is needed to gain better clarity and to enhance the prognosis.

What are the most common misconceptions surrounding mental health presently in the region?

There are three sections of people: first, those in academia with good awareness; second, those in the general populace with limited knowledge; third, those with no knowledge but with stigma towards mental health. Misconceptions can range anywhere from denial of depression to associating mental illness with weakness and violence. It is, therefore, important to bring all sections of people on common platforms for better knowledge flows. This can result in better consensus, which can translate to positive outcomes.

COVID-19’s impact on mental health was experienced all over the world. Were there existing mental health issues that plagued the population in the UAE, prior to the pandemic? How were these heightened?

Common mental health disorders are prevalent in the UAE. Depression, in particular, had been on a rise among the young population in the last decade. However, COVID-19 precipitated existing conditions and led to a rise in new cases due to mobility restrictions, financial setbacks, unemployment, death of loved ones, etc. Since the UAE is an expat-heavy economy, depression due to international mobility restrictions was common.

What are the main causes of mental health issues in the region?

The causes of mental health issues are as diverse and inexplicable as physical issues, if not more. We cannot have a cut-and-dry approach to linking mental health with specific risk factors. Likewise, the causes of mental health issues in the region are no different. By one estimate, nearly a third of the UAE battled mental health issues during the pandemic. That represents a large data set of socio-economic statuses, ethnicities, age groups, etc., with a multitude of causes. The objective is to treat each case separately with the best possible care.

Ally Salama, Founder, EMPWR

What is EMPWR’s role and how was it founded?

Founded in 2019, EMPWR is the world’s first Arabic and English digital peer-support network on mental health. It was founded to fill the need-gap for mental health platforms in the MENA region. We filled this gap through a digital-first approach, giving the youth a forum to access help and offer support to each other. EMPWR envisions itself as a beacon of hope for people battling mental illnesses in the region, its role becoming ever so important in the pandemic aftermath.

Can you tell us about EMPWR’s relationship with Wamda and Microsoft for Startups?

EMPWR was an exclusive mental health partner for WAMDA and Microsoft for Startups, in their research titled ‘The impact of COVID-19 on the state of mental health and wellbeing of entrepreneurs in MENA’. EMPWR helped formulate the questions for the survey, monitored the progress of the report, and was instrumental in enabling the partnerships needed for the research. It’s the coming together of people from different industries to shine a light on mental health, which can affect anyone.

The weight of the pandemic has been shouldered by numerous industries, what were the challenges faced by entrepreneurs and the startup industry?

The effect of the pandemic on the mental health of entrepreneurs has been disproportionate, to say the least. We found out that entrepreneurs are twice as likely to face depression. A resounding 35.9 per cent of entrepreneurs rate the state of their mental health as "bad"; only 9.9 per cent of entrepreneurs rate their mental health as “good”. These are alarming findings, which I believe will redefine how we see entrepreneurship.

How can this impact the growth of the startup industry and entrepreneurship?

Mental health issues can be as crippling as physical ones if not given timely care. Loss of productivity is a common effect of mental illnesses. And entrepreneurs can’t afford productivity loss. High incidences of mental illnesses among entrepreneurs will have a direct bearing on the performance of the whole startup ecosystem. It is, therefore, consequential to create good support systems and raise awareness in every community, including the startup industry.

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According to the report published by EMPWR, only 2 per cent of healthcare budgets in the MENA region are currently spent on addressing mental health. What can be done to overcome this to better address mental health?

The low budget is a reflection of entrenched notions surrounding mental health. We are actively trying to break these traditional notions. Furthermore, we should raise awareness, in mediums that are easily accessible to large populations. Social media, for instance, is a viable means to reach people, particularly the young population, and achieve greater consensus. Likewise, we have to create a common avenue for investors, governing bodies, policymakers, medical professionals, and the general population. Such multistakeholder participation is key to revisiting the budget for mental health. The development of EMPWR Hub stemmed from this belief.

How is the limitation of providers covering mental health, cost, and accessibility further hampering the reach of mental health care?

The exorbitant cost of mental health care is definitely the reason behind a lack of early intervention and hesitancy to seek help. We have a collective obligation to ensure that mental health care is accessible and affordable to all. Also, insurance providers and policymakers have a greater responsibility to this end. But, for patient-friendly policies to come to fruition, we need strong bottom-up efforts from the general population — which is where we come in.

Is there a disconnect between mental healthcare professionals and patients in the region?

The answer is yes and no. Mental healthcare continues to operate as a niche, largely obscured from mainstream healthcare. If you search for “doctors near you”, chances are they won’t be many psychiatrists. So, there is scope for a greater association between mental healthcare professionals and patients. At the same time, increased digitalisation and telemedicine have paved the way for better connectivity between healthcare professionals and patients. Going forward, with digitalisation expected to gain momentum, the connectivity will only increase. This will lead to greater awareness, healthcare accessibility, and affordability.

The COVID-19 pandemic has highlighted the necessity of public health measures in ensuring population health. The spread of SARS-CoV-2 infections has been considerably slowed by large-scale testing, contact tracing, social distancing, and mask use. However, new strains rising in many parts of the world have created urgency in identifying additional measures to help public health initiatives.

As we understand more about COVID-19, we may be able to adopt more focused approaches to infection prevention and treatment. According to a journal article published in Genetics in Medicine, precision medicine (PM) and precision public health (PPH), which attempt to customize treatment and interventions to a specific individual or population-level attributes, could be useful additions to traditional public health approaches.

Precision medicine emphasises more precise diagnosis and treatment based on a variety of biomarkers, such as genetic variants, as well as data about the environment, lifestyle, and behaviors of patients. Individual vulnerability and responses to COVID-19 may be better understood using PM methods.

For example, severe COVID-19 infections have been linked to gene variants on chromosomes 3 (3p21.31) and 9 (9q34.2), ApoE e4 genotype, and loss-of-function mutations on X-chromosome TLR7, according to current research. While the clinical importance of these polymorphisms is debatable, discoveries like these may provide some insight into why patients with comparable demographics and comorbidities can have such disparate reactions.

A better understanding of biological fragilities could lead to the development of targeted treatments. Considering recent results on COVID-19 genetic vulnerabilities, PM methods for developing future treatments could be similar to initiatives in oncology, where the patient's genetic predisposition and the tumor's genetics both play a role.

Precision public health, which involves using more accurate measures of disease spread, susceptibility, and behavior to assess population health and devise focused initiatives, can also help with larger COVID-19-related public health efforts. The importance of exact genetic information applies to both the virus and the host.

Pathogen genomics has been used to track the genetic variation of the SARS-CoV-2 virus and its propagation, which can assist local officials in making public health choices such as shelter-in-place orders and travel restrictions. Expanded genetic characterisation of SARS-CoV-2 may provide more comprehensive information on the virus, which can then be used to guide vaccine strain selection and improve vaccine effectiveness.

Additionally, after a vaccine has been established, PM methods have the potential to discover biological, genetic, and environmental factors that may affect vaccine response and imply that some groups require different dosages. Similarly, structural factors may have a role in the probability of COVID-19 transmission at the population level.

Residential segregation research, for example, demonstrates how neighborhood concentrations of poverty, exposure to environmental risks, and reduced access to nutritional meals and primary health care affect community health. As PM and PPH researchers employ increasingly "accurate" techniques, they should keep these underlying reasons in mind while interpreting and presenting data. Future interventions may incorporate both targeted preventive and treatment techniques as well as "basic solutions".

Artificial Intelligence in healthcare still seems like a fairy tale in many Latin American countries.

However, companies like Arkangel AI are helping the healthcare industry use algorithms to diagnose and treat diseases without having to write a single line of code.

"What we do is create technology to help health professionals or health systems deliver results much faster and much more scalable without any knowledge of coding or artificial intelligence necessary," said Laura Velásquez, President of Arkangel AI, in an interview for Omnia Health.

Velásquez explained that the company is helping with the early diagnosis and effective treatment of different diseases with the application of AI.

A diagnosis of fibrosis can typically take weeks for example, in which dozens of studies are reviewed by specialists who analye the case of the patient.

The same occurs with lung cancer, which can take up to three months to be correctly diagnosed; when this happens the patient is already at a late stage and there is not much that can be done.

With algorithms developed from AI, the verification of a medical condition can be reduced to two minutes and help the doctor make better decisions on medical treatment.

In addition, it is 90% accurate, as required by the WHO in the use of these technologies.

Velásquez assured that algorithms can also help doctors to enhance treatment, as with COVID-19: Arkangel developed a prognosis model for the patient with COVID when they were already in a clinical state.

When the pandemic began, she recalled, it took up to 36 hours for PCR test results to arrive and doctors did not know what to do to treat the patient, while confirming the disease.

“We decided to release these algorithms for free and help different municipalities in Colombia,“ Velásquez explained. “They used Arkangel to say ‘hey this is happening to the patient’s lung and we can do this, we can do that, it may be COVID or it may be something different.”

How Arkangel’s algorithms work

Arkangel has algorithms already developed for respiratory diseases, retinal diseases, parasitic diseases, such as malaria and Chagas disease, or bacterial, delivered to doctors, pharmaceutical companies or government health institutions the algorithms already trained for diagnoses or treatments.

“They acquire our license and the rollout begins. Our licenses are five times more affordable than those that currently exist because it’s 100% software and that allows us to make it more accessible,” explained the president of the company.

The second option available is for hospitals, companies or government to enter all data available into Hippocrates, software that analyses the data and generates a model that is then trained by the algorithm for a specific purpose.

“In the end, after several hours of training that can be from 40 to 200 hours, depending on the complexity of the data and the pathology, we deliver the model to you. This is an algorithm that enables early detection of diseases, or triages the patient, or whatever the entity requires, ”said Velásquez.

The advantage of using these algorithms and computers is that they do not tire and therefore they maintain their degree of precision, compared to a doctor who sees 30 patients a day, and who after eight patients already has the normal exhaustion of any person.

Furthermore, health centres, clinics and hospitals do not need large infrastructure to take advantage of this technology. Data from health systems show that 92% of hospitals have at least one X-ray machine.

"Although almost all providers are analogue in rural areas, we can use images still, because the doctors take a photo with their cell phone, they put it in Arkangel and they get the result," said Velásquez.

In the more remote areas where there is no internet, models can be worked on offline without any loss of precision, while remaining as fast as possible for the doctor.

Accessible healthcare, thanks to algorithms

Velásquez nonetheless assured that her dream was to take algorithms already trained in large urban hospitals to more remote communities, where there are no specialist doctors and where access to health services is more difficult.

"That is what we want - we have algorithms that we can already use in the field, in urban areas, in rural areas, whatever, and with these new ones we can train with Hippocrates say, 'Why can't we take it to any area that doesn't have access to this - it could be in Latin America or Africa or wherever',” she said.

Laura is confident that the industry will continue to embrace these new technologies and implement them in more healthcare systems and hospitals.

The next challenge, she says, will be the selection of patient data to continue training algorithms since, until now, no one has been given the task of classifying this data for use in personalised patient medicine.

Hospitals will further have better patient management and doctors will be focused on patient care, without having to learn to code these algorithms.

“We allow you to continue doing what you do, which is to be doctors, to provide patient care, and we take care of the back end that nobody sees as it is encoded around AI,” Velásquez concluded.

The UAE National Center of Meteorology’s (NCM) recent announcement that tropical cyclone Shaheen is expected to hit the eastern coast of the UAE, has been a warning for residents to expect a change in weather. A shift in climate conditions can impact the resilience of the human body’s immunity, making it more susceptible to exposure to viruses.

Pre pandemic, a high temperature, cough, and sniffles were common indicators of the flu. However, in the present day, these symptoms may point towards a very different diagnosis. As the flu season approaches, questions of how cases will be differentiated from COVID-19, its acute counterpart, and will it peak again, is on many minds. In an interview with Omnia Health Insights, Dr. Fadi Hamwi Consultant Internal Medicine, and Dr. Palat K. Menon Specialist Microbiology, Molecular Biology and Head of Clinical Lab at Fakeeh University Hospital, provide answers to these pressing questions.

Related: COVID-19 is mutating: what does this mean for us?

“The flu season marks its arrival in the region between summer and fall, peaking at the start of the school year. During December, January, and February, cases reach an all-time high. However, it is crucial to mention that influenza circulates throughout the year, rising in winter. One of the main causes of the increase in cases is notably weather change, and transmission due to crowding in schools,” comments Dr. Hamwi.

The climate’s influence on viruses can be significant as most diseases have a seasonal variation, with respiratory illnesses occurring typically during the winter months. “There are several contributing factors, with one of the most prominent being staying indoors and producing aerosols that are easily transmissible and have a greater incidence of cross-infection. In addition, an increased number of children returning to school immediately after holidays exchange their bacterial and viral genetic information,” adds Dr. Palat K. Menon.

Related: Is the COVID-19 effect on children's mental health deepening?

However, with COVID-19 threatening patient's health globally, the dynamics of the disease have changed due to behavioural adaptation in humans. “COVID-19 had a large influence on the seasonal influenza pandemic, which is usually experienced yearly. Measures implemented to tackle the COVID-19 virus, including social distancing, mandatory masking, and hand hygiene, have simultaneously facilitated the prevention of the spread of the influenza virus. Last year, we saw that seasonal influenza infections were at a minimal rate,” explains Dr. Hamwi.

“Masking lowers the ability of a human being to produce aerosols and prevents you from touching your nose. Most individuals touch their noses every few minutes, which is an ingrained behavioural trait. That infected hand goes through touching others, therefore, masking, practising hand hygiene, avoiding contact by not shaking hands, maintaining social distancing, are all factors which have helped in the reduction of influenza cases all over the world,” says Dr. Menon.

Similarities between COVID-19 and the flu

For specialists, during the pandemic, both influenza and COVID-19 are under the microscope. Dr. Menon explains: “The viruses are fairly similar in their mechanism of spread and only through testing can they be differentiated. Both Influenza and SARS- COV2 are RNA viruses, however, the membrane which covers the virus has differing protein structures. The ACE protein on the COVID 19 virus acts as a key opening the cellular doorway, by binding to the ACE2 receptor on the human cell. In contrast, influenza has two protein molecules known as Hemagglutinin (H) which is responsible for binding the virus to the cell being infected, and Neuraminidase (N) which cleaves the receptor to allow virus release. Scientists use these antigens to identify the influenza virus, hence the initial influenza viruses were called H1N1.

Current subtypes of influenza A viruses that routinely circulate in people include A(H1N1) and A(H3N2). (H2N2, H2N3), etc. When the antigens covering the virus suddenly change or when the immune system forgets or is unable to identify these new antigens, a pandemic starts. Therefore, when we look at COVID-19, various variants are rising due to the human body being unable to recognize the new strains. It is vital to monitor strains around the world and diagnose patients through both PCR and antigen testing to differentiate between the two viruses and to develop effective vaccine strategies.”

So, what does the future hold? According to Dr. Menon, the healthcare industry is amplifying its efforts in viral disease control through newer modalities of antiviral therapy. “Effective treatment options for influenza are accessible, however for COVID-19, we are still looking for effective antiviral agents. Vaccines play an important role in safeguarding individuals, for influenza we have a mixture of vaccines with combinations of antigens, and similarly, for COVID-19 many healthcare regulators are now considering mixed vaccines. It’s just a matter of time that we will develop these options further and add antiviral medication as an option to conquer COVID-19 effectively.”

“The best advice is to adhere to the proper precautions to prevent people from contracting COVID-19 and from contracting influenza. There are several types of seasonal cold and flu viruses and rhinoviruses that are similar to the symptoms of influenza. This can be extremely challenging for those who work in schools, offices, and for families. Therefore, it is vital to reduce the chances of being infected,” concludes Dr. Hamwi.

Researchers at Cleveland Clinic, in collaboration with the University of Alberta and the University of New Brunswick in the U.S., have engineered a first-of-its-kind bionic arm for patients with upper-limb amputations. The novel system combines intuitive motor control with touch and hand movement sensation allowing wearers to think, behave and function as a person without an amputation.

“We modified a standard-of-care prosthetic with this complex bionic system, which enables wearers to move their prosthetic arm more intuitively and feel sensations of touch and movement at the same time,” said lead investigator Paul Marasco, associate professor in Cleveland Clinic Lerner Research Institute’s Department of Biomedical Engineering. “These findings are an important step towards providing people with amputation with complete restoration of natural arm function.”

Related: Personalised prosthetic and orthotics in digitised world

The system is the first to test all three sensory and motor functions in a neural-machine interface all at once in a prosthetic arm. The neural-machine interface connects with the wearer’s limb nerves. It enables patients to send nerve impulses from their brains to the prosthetic when they want to use or move it and receive physical information from the environment and relay it back to their brains through their nerves.

To effortlessly complete an intentional movement, the brain needs feedback from the body regarding the movement’s progress. This largely nonconscious kinesthetic sense helps the brain learn relationships between motor commands and outcomes to correct movement errors.

Related: 3D printed legs offer new lease of life for Emirati double amputee

Prosthetic systems for restoring function have predominantly focused on controlling motorised joint movement. Without the kinesthetic sense, however, these devices do not become intuitively controllable.

The study reported a method for endowing human amputees with a kinesthetic perception of dexterous robotic hands. Vibrating the muscles used for prosthetic control via a neural-machine interface produced the illusory perception of complex grip movements. Within minutes, three amputees integrated this kinesthetic feedback and improved movement control.

Combining intent, kinesthesia, and vision instilled participants with a sense of agency over the robotic movements. This feedback approach for closed-loop control opens a pathway to the seamless integration of minds and machines.

“Perhaps what we were most excited to learn was that they made judgments, decisions and calculated and corrected for their mistakes like a person without an amputation,” said Dr Marasco, who leads the Laboratory for Bionic Integration. “With the new bionic limb, for the first time, people with upper limb amputations are now able to again ‘think’ like an able-bodied person, which stands to offer prosthesis wearers new levels of seamless reintegration back into daily life.”