20111004 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, OCTOBER 4, 2011

HEALTH POST Four survivors share their inspiring tales of conquering breast cancer >PAGE 4

Second chances

TEACHING KIDS THAT GRIME DOESN’T PAY >PAGE 6

NEW WORKOUT PUTS A POSITIVE SPIN ON FITNESS >PAGE 10

2 NEWS HEALTH BITES

A breakthrough for HIV The HIV virus has been a tough target for vaccine development as it suppresses, rather than triggers, the body’s immune response. But Johns Hopkins researchers have found a way to sidestep this barrier by modifying HIV. Previous studies had shown that cholesterol-depleted immune cells (white blood cells) cannot be infected by HIV, and this led the Johns Hopkins team to test whether HIV lacking cholesterol in its viral coat could still infect cells.

Testing on both human immune cells cultured in a lab and HIVpositive blood drawn from patients, the modified HIV was found to be able to trigger the body’s innate virus-fighting response. In the report, published in the journal Blood, the researchers say their work could lead to new HIV treatments.

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Jeanette Wang jeanette.wang@scmp.com

If you’re happy and you know it, tweet It seems that all over the world, people are happiest early in the morning and near midnight. Cornell University researchers, using language monitoring software, tracked 2.4 million people on Twitter in 84 countries over two years.

They found that this global cheer soon faded once the workday began. There were also more positive tweets on Saturdays and Sundays, with the morning peaks occurring about two hours later those days. Researchers found that work, sleep and daylight all play a role in shaping cyclical emotions such as enthusiasm, delight, distress, fear and anger. The study appeared in the journal Science.

Expecting? Hit the gym for the sake of your child Pregnant women who work out can reduce the chances of their new baby developing neurodegenerative diseases such as Alzheimer’s later in life. Doing tests on mice bred to develop a disease roughly equivalent to Alzheimer’s, scientists from University Hospital Essen in Germany found that the mice whose mothers ran on an exercise wheel regularly during pregnancy showed fewer signs of the disease later in life. They also showed greater brain plasticity, which indicates more and better connections between the nerve cells. “No one is resistant to the health benefits of exercise,” says Dr Gerald Weissmann, editor-inchief of The FASEB Journal, which published the report. “Whether you work out at home or go to the gym, you should do it for the sake of your health and that of your offspring.”

Take a load off your feet With running, any extra weight you carry slows you down. So adidas put its shoes on a diet and came up with the adizero Feather, its lightest everyday running shoe that weighs as little as a dozen five-dollar coins (160g for women’s British size 5.5, HK$799). It comes in a range of eyecatching colours – red, yellow, blue and pink – from adidas stores and selected retailers. See www.adidas.com.hk/running.

Crunch time for skincare This won’t count towards your five a day, but the Carrot Butter Cleanser (HK$590 for 70ml) from The Organic Pharmacy could give your skin a new lease of life. Carrot is blended with shea and cocoa butter, along with chamomile, rosemary and lavender, for a formula that claims to deliver a deep but gentle cleanse. It’s among a range of new products from the British organic skincare brand that returns to Hong Kong this month.

Check it out at Harvey Nichols.

APP OF THE WEEK

Graphic guide holds your hand day by day while you wait for the baby ......................................................

Katie McGregor healthpost@scmp.com BabyCentre My Pregnancy Today Free Rating 9/10 On the 14th week of my pretend pregnancy for the sake of this review, this app tells me what to expect in my second-trimester prenatal visit and reminds me to take a belly photo. There’s also a fascinating yet startling animated 3-D video of how a baby grows either into a boy or a girl.

Although it’s been some time since I was pregnant for real, I remember very clearly the insatiable hunger for information about your growing baby and about the birth itself. While I raised my dolls on the hand-drawn illustrations in Dr Spock’s Baby and Child Care, and

then my real babies on the ubiquitous but sparsely illustrated What to Expect When You’re Expecting, mothers have never had it so graphic.

This app takes a mother-to-be through her pregnancy day by day, with videos, annotated illustrations and plenty of expert advice and tips.

In a typical week, it covers changes in your body, describes your baby’s growth stage and suggests things to do, from spending time with your partner to eating a pregnancy super food.

It also discusses issues that may concern you during that time, such as feeling your baby move, or perhaps going to a rock concert while pregnant.

The app looks after you until your baby is two weeks old, and even then, you are not abandoned.

The app is produced by BabyCenter.com, which covers

baby and childcare issues from preconception to the developmental stages of your eight-year-old.

The nicest thing about this app, however, is that you can check it out anywhere, although you do need an

internet connection to view the videos. With your feet up on the sofa, in the waiting room for your check-up, and even in the middle of the night, you can feed your thirst for knowledge at a touch.

> CONTACT US Deputy Culture Editor: Choong Tet Sieu tetsieu.choong@scmp.com; Health Post Editor: Jeanette Wang jeanette.wang@scmp.com; General inquiries: healthpost@scmp.com Advertising: tel: 2565 2435; e-mail advertising@scmp.com

MEDICAL 3 CASE HISTORY

Shrink outside the box ......................................................

Eileen Aung-Thwin healthpost@scmp.com Seventy-year-old Mr Li always looked forward to his trips to Shanghai for some family time. His son was working in the city, and the joy of visiting him was doubled by the presence of his young grandson.

But on a trip in March 2008, Li (whose full name is withheld for confidentiality reasons) found he couldn’t concentrate on his usual activities; his stomach hurt and he had a fever. He brushed it off as flu until he felt so ill that he had to seek help at a local hospital.

It turned out Li was much more ill than he thought, and he was admitted immediately.

Shanghai doctors suspected he

The gamble paid off.

In three months, Li’s tumour shrank to 4cm … and could be surgically removed had a stomach tumour, based on screening tests. Li had surgery to assess his condition. His abdomen was opened from naval to ribs, and doctors found a large tumour in his stomach.

The monster lesion was more than 10cm wide and had latched on to important blood vessels. Doctors could not remove the tumour without damaging the blood vessels and causing a haemorrhage.

Without a treatment strategy, the doctors took a biopsy of the tumour and closed Li’s abdomen. The biopsy results showed Li had gastrointestinal stromal tumour (GIST), the most common type of mesenchymal tumour in the tract.

GIST, however, is much less common than stomach or colon cancers, with only 100 to 125 cases reported in Hong Kong each year.

The trouble with GIST is that its symptoms, such as abdominal discomfort, often mimic those of other conditions and are easily overlooked. As is typical of most GIST

cases, Li’s condition was already quite advanced by the time it was found.

But the Shanghai doctors did not give Li a clear picture of his condition.

In hospital for a month, he had little information about his diagnosis or treatment. Unhappy with this and losing faith in the doctors, Li returned to Hong Kong for a second opinion.

In Hong Kong, he saw Dr Chu Kin-wah, a specialist in general surgery. Chu confirmed that surgery – the most common and effective treatment – was out of the question because of the tumour’s size and location. He referred Li to Dr Jonathan Sham Shun-tong, of the University of Hong Kong’s clinical oncology department.

Sham knew GIST was triggered by a mutation in the KIT or PDGFRA genes. These genes are normally dormant, but when “awakened” for unknown reasons, they give out signals for certain cells to divide and replicate, creating a tumour. But a drug called Imatinib could stop the mutated genes from working.

Imatinib is a form of targeted therapy that affects only the metabolism of cancer cells. This is unlike chemotherapy, which attacks all rapidly dividing cells in the body – including hair follicles and those in the bowels, bone marrow and gonads – which give rise to side effects.

Imatinib, however, can cause weight gain, reduction in blood cells, headache, oedema, nausea and rash.

Sham had worked on other tumours that were inoperable because of their large size. In those cases, chemotherapy was used to shrink the tumour, which could then be surgically removed. As the GIST was not responsive to chemotherapy, Sham theorised that Imatinib could be used to shrink Li’s tumour.

At the time, it was a radical treatment plan for the GIST, and Sham did not have any evidence that it would work. But the gamble paid off. In three months, Li’s tumour shrank to 4cm, pulling away from the blood vessels so that it could be surgically removed safely.

As Li’s tumour was originally larger than 10cm – deemed a high risk and with greater risk of recurrence – he had to continue Imatinib therapy for a year. Two years later, he’s still healthy, enjoying frequent Shanghai trips to see his family and living an active life.

Illustration: Angela Ho

ASK THE EXPERTS BARBARA QUINN Q: Could you tell me what minerals/ vitamins/nutrients end up in the water used to steam or boil veggies (and fruits, if it applies)? I realised there are nutrients of some sort in the water, so I began dumping the water on our rose bush. The rose bush thrives on this water. Because of that, and reading about saving the water for soup stock, I started putting it in containers in our fridge. One night I drank some of the cold water. It was refreshing and tasty (tasted like the veggies steamed in it).

Would you say the leftover water at the bottom of the pan is healthy for someone to drink?

A: Yes, it is. Water-soluble nutrients like B vitamins and vitamin C, as well as minerals such as calcium, iron and zinc, can all leach into the water when vegetables (and fruit) are cooked.

Nutrition researchers from the University of California at Davis confirm the age-old advice to cook vegetables quickly in less water.

And, they say, we can increase our daily nutrient intake if we also consume the water used for cooking.

Use it soon, however. Minerals will survive in storage, but vitamin C won’t last long (even in raw vegetables). If you don’t intend to use cooking water

soon for soup or a sauce, sip it for a super-nutritional side effect.

Vitamin C seems the flightiest of nutrients. It is lost during storage, through heat and exposure to air.

Cutting an orange into small pieces, for example, exposes it more and increases the loss of vitamin C. How to get the most vitamin C out of a fruit or vegetable? Eat it right away.

McClatchy-Tribune Barbara Quinn is a registered dietitian at the Community Hospital of the Monterey Peninsula in California

4 COVER STORY

Only half A poor lifestyle is putting Hong Kong women at risk of breast cancer, a study has found. Survivors of the disease tell Elaine Yau how it changed their lives

"I worked from 7.30am to 1am every day."

Alice Ho Yuet-ming, 56, could not accept her illness when she was first diagnosed with stage one cancer after a mammography screening in 2006. “I kept asking why the world was so unfair, as I have never harmed people,” says the social worker, who has been counselling families involved in domestic violence for 28 years.

Work stress, she says, was the cause. In the year leading up to the diagnosis, she had to stand in for her absent boss, working nearly 16 hours every day, sometimes dealing with high-risk cases. “I seldom exercised. There was little time to spend with my family and friends.”

She was spared chemotherapy as the cancer had not spread to the lymph nodes.

But reading up on the condition on the internet created fear in her. She thought radiotherapy would leave her skin charred, and she refused a mastectomy until her daughter returned to Britain to study.

Her worries lessened after she joined sharing sessions at the Breast Cancer Foundation. “A quarter of my right breast was removed. The 30 radiotherapy sessions over two months were OK. The skin in the affected area was a bit itchy and I felt tired near the end.”

She says the disease was a blessing in disguise that changed her personality. “My colleagues were afraid of me, as I was notorious for being pushy ... After I recovered, I picked up tai chi and turned to part-time work, devoting the remaining time to volunteer counselling work at the foundation. I feel great that my experience in fighting the disease can help patients ride out the most difficult time in their lives.”

T

ransforming ideas into commercials and billboards around the city used to be Liang Po-tin’s source of great satisfaction. A selfconfessed perfectionist and workaholic, her job as a high-flying advertising manager was her life, working until as late as 2am.

That is, until an ultrasound test last October revealed she had late stage two breast cancer. “I was devastated,” she says.

Fortunately, half a year of surgery and chemotherapy treatments helped. She returned to work last month armed with an entirely transformed outlook on life. “[Now], I slow down my pace and devote more time to exercise, which I seldom did in the past.”

A poor lifestyle puts a lot of women at risk of breast cancer – the most common cancer among local women – says Dr Sharon Chan Wing-wai, clinical director of the

Kowloon East Cluster Breast Centre at United Christian Hospital.

The biggest culprit is the lack of physical activity, according to a report issued last month by the Hong Kong Breast Cancer Foundation (HKBCF). Of 5,393 patients surveyed, 72.5 per cent lacked exercise, with only 4.3 and 5.8 per cent being smokers and drinkers, respectively. Other risk factors cited include not breastfeeding (59.8 per cent) and high stress levels (36.1 per cent).

Chan says the incidence of breast cancer rose from 1,918 cases in 2000 to 2,701 in 2007 – or by 41 per cent. The median age of local patients when they get diagnosed is 48, far lower than the 60 for the United States and Australia.

“One in 21 women falls prey to it now,” Chan says. “Eighty per cent of patients covered in the report do not have a family history of the disease. Many of them are not smokers or drinkers. Thinking that

30 • Percentage of cancer patients at Pamela Youde Nethersole hospital who underwent breast retention surgery (1994-2007)

Photos: K. Y. Cheng, David Wong and Edward Wong

COVER STORY 5

the battle they are unlikely to get breast cancer, they lack the awareness to get regular medical check-ups.”

Breast screening, including selfexamination and mammography, is an effective tool for early detection, says HKBCF founder Dr Polly Cheung Suk-yee. But the report found fewer than three in 10 local women had a mammography screening before diagnosis, far lower than in New Zealand (80 per cent), the US (66 per cent) and Australia (55 per cent).

“Patients diagnosed at early stages have a lower chance of requiring a mastectomy, chemotherapy or nodal surgery,” Cheung says. “Early detection not only helps increase survival rate, but also saves undesirable suffering and medical expenses.”

During stage two, the cost of surgery and follow-up treatment can be as much as HK$650,000, Cheung says. But cancer detected at stage zero or one may only require

One in 21 women gets breast cancer. Thinking they are unlikely to get it, they don’t get regular check-ups DR SHARON CHAN WING-WAI, CLINICAL DIRECTOR, KEC BREAST CENTRE

surgery, which can save up to 80 per cent of the cost.

If a biopsy of lymph nodes near a breast tumour shows the cancer has spread, surgeons will remove the nodes from under the arms to prevent it spreading further.

Patients with breast cancer cells that have oestrogen or progesterone receptors (hormones that stimulate the growth of cancer) will need to take growth-inhibiting drugs typically for years after surgery, chemotherapy and radiotherapy.

The side effects can be debilitating, especially the partial or full removal of breasts, which may undermine one’s womanhood.

However, a new breast retention surgery – local mammoplasty – introduced by the United Christian Hospital and the Hong Kong Sanatorium and Hospital offers hope, especially for women with small breasts, Chan says.

In the past, those with tumours

bigger than 10 per cent of the breast size could not have a partial mastectomy as the surgery would cause the breast to crater in parts, she explains. With the tendency for small breast size and late diagnosis in local women, the surgery rate in Hong Kong has therefore been low.

A study by Pamela Youde Nethersole Eastern Hospital found only 30 per cent of patients underwent breast retention surgery from 1994 to 2007, compared with 80 to 90 per cent overseas.

With the new surgery, parts of the remaining tissue in the breast are relocated, making breast retention surgery possible for cases involving tumours which account for up to 30 per cent of the breast size. “The reconstructed breast will be smaller in size, but it won’t crater. The skin feels smooth and symmetrical,” Chan says.

Another treatment breakthrough is the recently introduced Oncotype DX test,

which looks at the molecular features of cancerous cells in a breast tumour tissue sample to assess the possibility of cancer relapse. The test is for patients suffering from an early stage of cancer, and whose cancer is oestrogen-receptor-positive and has yet to spread to lymph nodes.

In the past, doctors had only looked at pathological features – such as tumour size, grade and proliferation – to decide on the course of treatment. Chan says the test has helped reduce unnecessary chemotherapy and its associated side effects, citing research done several years ago that found 26.7 per cent of 1,000 patients studied had their treatment plan changed after the test, with chemotherapy eventually deemed unnecessary. elaine.yau@scmp.com October is Breast Cancer Awareness Month, so we asked four survivors to share their stories.

“My marriage caused a lot of emotional stress.”

Reeling after a painful divorce from her gambler husband, Cheung Yuen-ching (right) worried about supporting her son. When she felt her life could not get worse, she felt a lump in her right breast. She was later diagnosed with stage one breast cancer.

“My marriage made me feel very bad. The frequent harassment from creditors and fights with my husband gave me insomnia. Being emotionally unhealthy can lead to cancer,” says the former tutor, 51.

This was nearly 10 years ago. While Sars raged, she battled cancer alone, with surgery to remove her whole breast and four chemotherapy shots spanning four months. She stopped work and applied for unemployment benefit.

Cheung says the disease brought her out from her self-contained world. “For years before my divorce, my life was nothing more than tending to my son and working to help repay my husband’s gambling debts. My social circle expanded a lot after I joined the Hong Kong Cancer Fund, where I met all kinds of cancer survivors. I attended lessons on yoga, emotional health and good eating. We were taught how to accept the possibility of relapse and deal with death. I go swimming with my cancer survivor friends often now.”

After recovering, she found a job as a saleswoman at a clothing shop. She volunteers at the Cancer Fund and Prince of Wales Hospital, and teaches yoga at social centres. “I feel that I was given another chance in life and I want my remaining days to be meaningful and productive.”

“The nurses called me ‘moonface’.”

After feeling lingering pain in her left breast, Liang Po-tin (above) went for an ultrasound test last October and was diagnosed with late stage two breast cancer. She blames poor eating habits for her condition.

The advertising manager was also obsessed with work and could not stop thinking about her job, even on holiday. “Whenever my ideas got adopted by clients, I was giddy with success.”

She stopped work to have surgery and chemotherapy. While the treatment ailed her body, she was most crushed by the effects on her appearance. She lost her whole breast as the doctor had to remove 17 lymph nodes. Twenty shots of chemotherapy caused her hair and eyelashes to fall out. “My face, filled with pimples, was so swollen that the nurses called me ‘moonface’. I gained 7.7kg during treatment. It was a huge blow to my self-image.”

She spent HK$50,000 on plastic surgery for a tram flap breast reconstruction, where a part of her stomach tissue was relocated to the breast, leaving two big gashes on her stomach and a scar on her breast.

Back to work last month, Liang says her priorities in life have changed. “I seldom exercised, but now I [work out] every other day. I no longer eat cavalierly and consume plenty of fish, vegetables, fruit and little red meat. I have learned to take things easy at work, leaving at 6:30pm. I stop taking everything for granted and treasure my health and family a lot now.”

“I thought cancer could wait.”

A perennial optimist, breast cancer hardly put a dent in Connie So Yun-ling’s (left) happy outlook on life.

“When clumps of hair began to fall out after the first chemotherapy shot, I asked my husband to shave my head. It turned out that I look very good when bald. It was well-received by everybody,” says So, 48, who was then working for a wedding company.

The partial mastectomy left her breast cratered, but she was hardly devastated. “I felt I was prettier, especially with my newly grown hair.”

In 2009, a masseur had felt a lump in her left breast, but thinking the bean-sized tumour could wait, she went ahead with a six-day holiday in Beijing. “It was such great fun. But the tumour grew fast and it measured 2.1cm after I came back.”

She was diagnosed with stage two cancer.

These days, her activities include yoga and hiking, rather than just mahjong. Volunteer work at the Cancer Fund and Tuen Mun Hospital keeps her busy. She gives counselling and teaches hair-dyeing at the Cancer Fund. “I just work on wedding expositions that are held a couple of times a year, now. With my son and daughter both earning money, I think it’s time for me to put my feet up and enjoy life... I am busier now than when I was working full time. There are so many appointments that I have to keep a schedule book to mark everything down.”

6 HEALTH PREVENTION

Student grime fighters help y Above and far right: Belilios Public School students make puppets; Dr Yang Zhenbo scrubs up; (from left) Ngai Tsz-kwan, Siu Hiu-ki and Lau Hok-kee

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Jeanette Wang jeanette.wang@scmp.com Form Four student Siu Hiu-ki, 15, spent three hours last Wednesday after school attending a puppetry course led by instructors from the Ming Ri Institute for Arts Education, learning scriptwriting, prop sewing and performance techniques.

It was all in a day’s work for Hiuki, one of 44 student leaders for the fourth annual Global Handwashing Day on October 15.

Recruited by the Hong Kong Committee for Unicef, these volunteers are being equipped with creative skills that will be used to promote personal hygiene and hand washing to younger children.

In teams of four, the student leaders will take their puppet shows on the road to more than 20 kindergartens citywide until the end of the year, as part of Unicef’s new “hand washing school promotion campaign”.

“We volunteered because we love to help others and enjoy playing with children,” says Hiu-ki, who is joined by her Belilios Public School mates Ngai Tsz-kwan, Lau Hok-kee and Fok Hei-nam, all 15.

A week earlier at Unicef’s Happy Valley office, the students had a session with Dr Yang Zhenbo, chief of the water, sanitation and hygiene programme for Unicef China, where they

learned about the organisation’s water and sanitation projects around the world, and were taught proper hand washing.

“We didn’t know it involved so many steps,” Hok-kee says. “We usually just rub our hands with fingers crossed.”

Clean hands are important because they save lives. The statistics are grim: Yang cites the latest figures from a study last year in The Lancet, which found that some 8.8 million children under five years of age died in 2008, twothirds of whom died from infectious diseases such as pneumonia (18 per cent) and diarrhoea (15 per cent).

Many lives could be saved by the simple act of hand washing.

Yang says 88 per cent of deaths from diarrhoea were due to lack of safe water, sanitation or hygiene, while 23 per cent of pneumonia deaths could have been avoided by hand washing with soap.

New studies suggest that hand washing promotion in schools can play a role in reducing absenteeism among primary school children.

On the mainland, for example, promotion and distribution of soap in primary schools over a fivemonth period resulted in 54 per cent fewer days of absence among students compared to schools without such an intervention, according to a 2007 study in The American Journal of Tropical Medicine and Hygiene.

That’s why the Hong Kong Committee for Unicef’s initiative targets schools. Global Handwashing Day promotional kits will be handed out to local schools free of charge, consisting of posters, stickers, video and audio materials, as well as a planner’s guide. Subsidies and a travel allowance will also be given to student leaders for conducting school tours. “Children can be catalysts for change,” says Simmy Li, an assistant manager at the Hong Kong Committee for Unicef.

A lot of people [think] our environment is better and free from contaminants, so we don’t have to wash our hands all the time DR YANG ZHENBO, UNICEF CHINA

Globally, hand washing isn’t as common as you think. Yang says that through observational surveys, hand washing with soap at critical times, such as after using the toilet and before handling food, ranges from zero to 34 per cent.

He notes that the low figure typically comes from developing

countries, where clean water, soap and sanitation are lacking.

“But we can’t say that in developed countries the rate is 100 per cent,” he says. “A lot of people have the mindset that our environment is better and free from contaminants, so we don’t have to wash our hands all the time.”

The fact is that hands are vehicles for disease-causing pathogens, travelling from person to person either through direct contact or indirectly via surfaces.

Hands that are not washed thoroughly with soap after being in contact with human or animal faeces, bodily fluids like nasal excretions, and contaminated food or water can transport bacteria, viruses and parasites to unwitting hosts.

Water alone is not enough, and neither is a token sprinkling.

Hands need to be washed and scrubbed with soap that’s foaming and slippery for 20 seconds – or as long as it takes to sing Happy Birthday twice.

Each person has a duty to everyone else to maintain personal hygiene. Take Sars for example: several studies done during the outbreak in 2003 showed that hand washing with soap more than 10 times a day could reduce Sars transmission by 55 per cent.

“Hand washing is not just one person’s business,” says Yang. “It’s everyone’s business.”

Handy tips for squeaky clean mitts 1 Squeeze some soap or sanitiser gel onto the palm of one hand. Rub palm to palm.

2 Rub the back of interlaced fingers.

3 Rub palms again with fingers interlaced.

4 Rub both palms with fingertips.

5 Rub thumbs with opposite palms.

6 Rub both wrists. Wash hands under running water using soap. Rinse and dry thoroughly.

1

The entire sequence should take about 20 seconds – just sing Happy Birthday twice.

2

3

HEALTH 7

youngsters clean up their act Students learn the proper hand washing technique.

Photos: Felix Wong, Simmy Li

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5

6

8 HEALTH FROM THE EXPERTS

WORKPLACE KEEPING FIT

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Dr Richard Lau and his team healthpost@scmp.com How are psychological disorders diagnosed? Psychologists will see whether someone’s presenting problem meets the established criteria for a specific psychological disorder.

For instance, if someone is depressed, psychologists might diagnose from the Diagnostic and Statistical Manual of Mental Disorders (DSM) to see whether his/ her problem meets the criteria for major depressive disorder (MDD).

Some criteria for MDD are “depressed mood most of the day”, “markedly diminished interest”, “insomnia or hypersomnia” and so on. If the problem meets those criteria, the client will be diagnosed accordingly. But where did those criteria come from?

In 1898, the Munich psychiatrist Emil Kraepelin produced a comprehensive classification system.

Before that time, there were great inconsistencies in classification. In 1948, the World Health Organisation published an edition of the International Classification of Diseases that contained a complete listing of mental disorders. The American Psychiatric Association produced DSM-I in 1952 and DSM-II in 1968. The first two editions were heavily influenced by psychoanalytical concepts of mental illness. The definitions of each disorder were vague, and the symptoms not detailed.

DSM-III, published in 1980, was the first attempt to use research in the development of diagnostic categories. The definitions of each disorder became more specific.

DSM-IV was published in 1994 and included a clinical significance criterion in almost half of its categories, that is “the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning”. A great deal of empirical data was also included in this edition.

The latest version, DSM-IV-TR, was published in 2000, updating information on each diagnosis.

DSM-5 is in consultation and due for publication in May 2013.

Although the DSM is used by psychologists, researchers, medical agencies, insurance companies and policymakers worldwide, it has attracted controversy and criticism.

The most fundamental scientific criticism of the DSM concerns the reliability and validity of its diagnoses.

Some argue the manual lacks reliability because different diagnoses

Employees who exercise are more productive, study finds ......................................................

Jeanette Wang jeanette.wang@scmp.com

Illustration: Corbis

Keep an open mind share many criteria, and the decision to allocate one diagnosis or another to a client is to some extent a matter of personal prejudice. In fact, diagnosis is quite subjective and may well vary from clinician to clinician.

Some think the DSM also lacks validity because co-morbidity between different disorders is very common. For instance, 75 per cent of people with MDD are diagnosed with at least one other psychological disorder. However, some argue that while early editions of the DSM were

Seventy five per cent of people with MDD are diagnosed with at least one other psychological disorder

merely a guide to psychiatric diagnoses, DSM-III and subsequent revisions were much more authoritative.

Besides using the DSM, psychological diagnosis also relies on different psychometric assessments, theoretical and empirical literature, the psychologist’s own experience and client data, such as personality traits and life history.

Physical medicine has progressed to a point where the etiology of diseases can be identified with relative certainty, while the etiology of psychological disorders is still quite ambiguous. Therefore, psychological diagnosis is not just the naming of the disorder, but determining the “why” of the symptoms associated with it.

So psychologists have to ask, “Yes, he is diagnosed with MDD, but why?”

Dr Richard Lau is the director of psychological services with the Whole Person Development Institute and a former assistant professor in the faculty of medicine at Chinese University

A physically fit workforce can raise annual productivity by A$2,500 (HK$19,800) for every employee.

That’s according to results released last month of a clinical trial conducted by Swinburne University’s Brain Sciences Institute involving employees from SAP AG Australia, an enterprise application software company.

“The research showed that there is a very clear link between physical fitness and brain function,” says Professor Paul Taylor, founder of the Body-Brain Performance Institute in Australia, and co-founder of a sister institute in Singapore.

The trial – which ran over 60 days from April to June this year – involved 40 randomly selected SAP employees in Melbourne.

They were split into two equal groups: both did a walking programme of 10,000 steps a day, while one group had additional gym sessions three times a week that focused on resistance training.

A neuropsychological test battery developed by Swinburne University was used to measure various important aspects of brain function that are typical for managers and executives, says Marcel Daane, managing director of the Body-

Brain Performance Institute in Singapore.

These include the ability of the brain to plan, remember, simulate future scenarios and make decisions.

The tests found that physical activity is good, but more vigorous exercise is even better.

“There were improvements in the employees’ mood and cognition from both of the groups, with the exercise group surpassing the results of the control group,” says Taylor.

The exercise group showed significant increases in alertness and energy levels. Their anger and stress levels also “dropped significantly”, while the walking group showed no improvement in this area.

Working memory – needed for complex tasks such as reasoning, judgment and decision making – improved by 2 per cent with the walking group and by 4 per cent with the exercise group.

Both groups improved their reaction time, but the exercise group arrived at decisions much faster – and more accurately.

With the average Australian office worker walking between 3,000 and 5,000 steps a day, SAP Australia will start a 10,000 steps walking programme, supported by an online wellness platform developed by the Body-Brain Performance Institute.

Exercising the body keeps the brain in better shape. Photo: EPA

DIET 9 NUTRITION

A model chef who ate to lose weight ......................................................

Jeanette Wang jeanette.wang@scmp.com We’ve heard it all before, those flabto-fabulous stories of miracle diets, gastric bypass surgery and intensive workout plans that have shrunk people from a size 16 to a six. But have you heard of the one about the 18-year-old obese boy from London who kept eating to lose weight – and didn’t step into the gym once?

Neither had I until I met Daniel Green a fortnight ago at Kowloon Shangri-La’s Angelini restaurant, where the celebrity chef whipped up a one-night-only healthy Italian dinner for hotel guests.

This former model once packed 92kg on his 1.76-metre frame, the result of a junk-food diet that began in his early teens. The turning point came one day at a downtown shop, where the biggest pair of trousers available was still tight on him.

“I suddenly realised that if I carried on this way, I’d have to go to a speciality store to buy my clothes,” says Green, 41, now a trim 70kg. “I felt that was a disability … I had to do something.”

So, he hopped on the fat-free diet trend of the ’90s – ironically, counter-intuitive to the highprotein, low-carb plans of today – giving up McDonald’s and pizza for pasta and potatoes.

It was boring, uninspiring and bland, says Green, but the kilos did begin to drop off.

A holiday to Thailand, however, was what really tipped the scales in his favour. There, he discovered a cuisine that agreed with both his taste buds and his waistline.

“I was having things I never had

Daniel Green shed nearly 30kg through healthy eating.

Photo: K. Y. Cheng

before, like tom yum goong soup, and I thought, wow, this is what I can eat. And it was just brilliant, and it inspired me,” says Green. “Most people come off diets because they don’t like the food they’re on. I was actually having better food, so there was no reason to go back.”

For the next three years, he continued eating well but healthily, whipping up “amateurish” meals at home inspired by recipes from cookbooks and magazines.

Enjoyment eventually turned to passion and – then working full time in retail with Benetton and modelling part time after losing nearly 30kg – he began making more “sophisticated” food.

Over the following three years, he hosted dinner parties and catered as a hobby. He would document his recipes with photos, compiling a

RECIPE FOR HEALTH

Fishing for compliments ......................................................

Daniel Green healthpost@scmp.com This dish is big in a lot of restaurants today. It’s actually pretty healthy.

But if you go to a restaurant they might add deep-fried leek on top, or some tempura on the side. I just make sure I don’t add any extra fat.

Spicy miso sea bass Ready in 35 minutes Serves four 2 tbsp miso paste 2 tbsp mirin

1 tbsp honey 2 tsp sesame oil 2 cloves garlic, crushed 4 sea bass fillets (about 150g each) 2 tbsp hot buffalo wing sauce Serve with jasmine rice •Mix the miso paste, mirin, honey, sesame oil and garlic.

•Brush the glaze over the fillets and place on a baking tray.

•Place under the grill or broiler for between six and eight minutes, until the top has browned.

•Meanwhile, mix the remaining glaze with the buffalo sauce.

•Serve with the fish on a bed of rice.

Celebrity chef Daniel Green is known for fuss-free and healthy food like this easy sea bass dish.

Photo: K. Y. Cheng

collection of his favourite dishes that helped him to lose weight.

In 2000, Green answered a call by Good Food magazine looking for “the next Jamie Oliver”, motivated by the desire to share his creative healthy recipe ideas. He won the competition, which earned him a magazine feature and television show reel. One thing led to another

and 11 years later Green has written six cookbooks, appeared on and hosted a number of cooking shows on major British television networks and is now based in Minneapolis, Minnesota, in the US, where he hosts daily shows on ShopNBC as well as his own cooking segment, Kitchen Takeover.

So what does he say are the main culprits when it comes to poor diet?

First, processed food, which is becoming more prominent in Asia; Second, a lack of thought and planning about eating properly, which leads to poor choices.

“And lastly, it’s not focusing on really good food you like,” he says.

“So diets cannot be sustained and you just take the bad option.”

That’s why he bases his craft on modern, flavourful, healthy food with as little fat as possible. On some days, however, he does indulge, giving in to his cheese craving with a huge pizza and buffalo chicken wings with blue cheese. His diet philosophy, after all, is “what you do on average”.

“You have to have a day off,” says Green. “You have to have a meal once a week that you absolutely love and enjoy, so you never feel like you’re restricting yourself.”

DANIEL GREEN ON …

The best meal he’s ever had “It changes all the time, but one of the best restaurants I’ve been to in recent times is La Beaulieu in Bangkok, by chef Herve Frerard.

That was brilliant French food.”

His recipes “They’re very easy to prepare, because my background is not from a culinary school and … it’s not like I’m selling a restaurant that serves food at US$500 a head and then people realise it had just three ingredients and was so easy to make.”

Going to the gym “I’m very active. I don’t walk; I run.

I’m always moving … I’ve just never been [bothered] to go to the gym, but at my age I probably should start thinking about it.”

What his last meal will be “Foie gras, steak tartare with French fries, a plate of oozing French cheese, and champagne all the way through. And if I did that every day, it would be my last meal.”

10 FITNESS SWEAT KBT ......................................................

Jeanette Wang jeanette.wang@scmp.com I’d always been intimidated by those big, brown, crescent-shaped leather bags in the gym.

Often a burly guy would hoist one up on his shoulders like an oversized neck pillow, then, grabbing it by each tapered end, whip it overhead back down on the ground like a professional wrestler body slamming an opponent.

So when I was offered professional instruction on how to use the Bulgarian bag, I pounced. I was keen to learn how the training tool, created in 2005 by former Bulgarian Greco-Roman Olympic athlete Ivan Ivanov, could help improve my athletic ability.

And I was hoping that Kahei Tse, training manager for Pure Fitness’ recently launched programme “kettlebells, Bulgarian bag and TRX” (or KBT for short), would help me overcome my fear of the medievallooking bag.

The KBT programme consists of three 45-minute introductory sessions that focus on basic technique and safety to get you acquainted with the three trendy training tools.

I’d previously dabbled in kettlebells – Russian cast-iron weights used for ballistic exercises – and the TRX, which is made of two straps that facilitate bodyweight exercises. But using them with coaching and feedback from an expert was new and appreciated.

These tools, after all, aren’t like traditional, one-dimensional methods of working out such as lifting weights or running on a treadmill. Instead, they work the body as a unit, through multiplanar movements, strengthening it for everyday activities – what Tse calls “functional exercises”.

With the wrong technique, it’s easy to get injured.

“Every swing, lift, press, pull, lunge or squat engages each joint and muscle group, forcing the body to always work as a unified whole,” says Tse, who has a degree in exercise science from Indiana University. “KBT is top for fat-loss, core stability and strength training, and really builds cardiovascular endurance as well. You could say it’s an all-in-one programme when done right.”

My lunchtime session at Pure Fitness in the IFC Mall kicked off with a five-minute chat where Tse asked about my expectations, goals, familiarity with the equipment and training style. Though there is a set lesson plan, this helped him to tweak it to my fitness level, experience and targets.

After five minutes of warm-up exercises focused on loosening the upper body and hips, we started the workout proper. The usual KBT

Kahei Tse of Pure Fitness (right) shows Jeanette Wang (below) the KBT (kettlebells, Bulgarian bag and TRX) workout.

Photos: Jonathan Wong

A new bag of tricks to help you stay fit programme comprises 45 minutes on each tool, but I was getting a 45-minute crash course in all three.

Most time, however, was spent on that Bulgarian bag.

Picking up the smallest of five sizes, a 5kg XS (it goes up to XL, or 23kg), I held it by its ends in front of my body, arms relaxed and dangling. I stood with feet slightly wider than shoulder-width, knees softly bent, head up and with a very slight forward lean. This stance provides a better base for speed and explosive moves, according to Tse. Then we simply began swinging the bag from side to side while keeping the feet flat on the ground.

This was simple enough; momentum did most of the work.

But next I had to translate this into an open spin, a foundational movement that builds core strength, rotational power and full body development.

The bag had to flow in full circles around the body, swinging over and behind the head, and back down below and in front of the shins.

I was afraid of knocking myself out, or losing grip of the bag midswing and knocking someone else out. The secret of a good spin, I soon discovered, is to be fearless, keep the core engaged and translate momentum on the downswing into an explosive upswing using the hips. Get a good momentum going and it’s like riding a bike on downhill hairpin turns – and hard to stop.

In fact, because of the immense pulling force the bag exerts on you, I nearly injured my arm trying to slow it down.

There are other movements that can be done with the bag – squats, lunges, twists, bends, pushes, pulls – but the spin is enough to keep you busy for a long time.

Every swing, lift, press, pull, lunge or squat engages each joint and muscle group KAHEI TSE OF PURE FITNESS

With KBT, the focus is on short but high-intensity intervals. For example, to finish off the session, I did a circuit of 10 bag spins in each direction, 10 kettlebell swings and 10 TRX push-ups, twice over. If it sounds like nothing, my elevated heart rate and fatigued upper body proved otherwise.

According to Tse, a study by the American Council on Exercise found that a 20-minute kettlebell workout burned at least 20.2 calories per minute, which is equivalent to running at a speed of 16km/h.

While Tse said I was in “pretty good shape”, I could do with more work on improving my timing, rhythm and flexibility, and learning to use my whole body. I’ll certainly be doing so, now I’m no longer intimidated by the Bulgarian Bags.

For more on the KBT programme, see www.pure-international.com/KBT2011.

WELL-BEING 11 PERSONAL BEST

THE TASTE TEST DRIED FRUIT

The wrench of the bench ......................................................

Zhang Tingjun healthpost@scmp.com As an athlete I have always played for the love of the game – a pure, simple and passionate love for sport. I trained six days a week for over 10 years with Singapore’s national netball team, including every Friday night and Saturday morning. I missed family holidays, weddings and birthday dinners, including my own.

Olympic gold medal-winning wrestler Dan Gable once said: “Gold medals aren’t really made of gold. They’re made of sweat and determination and a hard-to-find alloy called guts.” I’m proud of my country and team, and though we might never win the World Championships or Commonwealth Games, it can never be said to be due to a lack of sweat, determination or guts.

In fact, like many of my teammates, there are few things in my life that I have approached with as much of these things. I dedicated not only time, but also all my heart and my soul to netball. Successes and failures on court were therefore hugely significant to me, and I would never go down without a fight.

Over the years, I learned the importance of teamwork, how to perform under pressure and how to break through physical pain and personal boundaries. I understood the game, its

strategies and how to conduct myself as a gracious winner or loser. I was – or so I believed – a mature, well-rounded athlete.

In my 10th year as a national netball player, however, I would face my first real emotional challenge, one which proved to be my Achilles’ heel.

Singapore hosted the Five Nations Cup, one of the most anticipated competitions of the year, in September 2007. By international standards, it was a relatively insignificant competition, but it was important to us as it was the last major event before the World Championships that year. My friends, family and colleagues came down to lend their support over the six-day tournament.

As it turned out, I was benched for the first time for a critical game on home ground.

Over the years, I had been sidelined a few times, including once when I tore my ankle ligaments falling down a flight of stairs. This time, physically, mentally and emotionally, I was more than ready to take to the court, but completely unprepared to take the bench.

Over the course of the competition, I was forced for the first time to grapple with feelings of extreme disappointment, insecurity and shame in my new position as a reserve player. Unlike other teammates sidelined by injury, I had no shield, badge of

honour or point of sympathy to hide behind. I also had not built up the emotional tenacity to conduct myself with the grace and humility of a respectable athlete.

I felt frustrated and helpless as I faced the reality that maybe my best was no longer good enough. I also feared that I had let down my friends and family, and was ashamed that my new colleagues might assume I was “just” a reserve player. The emotional challenge I faced at the time was heartbreaking, and the learning curve gut-wrenchingly steep.

One night, while confiding in a teammate about my disappointment and frustration, my coach walked into the room.

Caught off guard and vulnerable, I broke down when asked what was wrong. I hated myself for it afterwards; being sidelined was no excuse to be weak or a burden to the team. There are only a few allowances I give myself as an athlete, and crying because I was

I felt frustrated and helpless as I faced the reality that maybe my best was no longer good enough

benched is not one. For the rest of that competition, I kept my emotions in check, and focused on supporting my teammates.

We walked away with the winning trophy, a bitter-sweet victory that I never truly felt I earned. My passion for the sport had taken a beating – or was it my pride? I took a break from netball after that tournament to figure out which it was.

Ironically, my time on the bench taught me more than I have ever learned in all my years as a starting player. It gave me a new level of respect for the game, and, by breaking me down, showed me where I was lacking as a player and what it takes to become a great athlete.

It’s taken a while, but I have finally returned to playing netball.

Recharged and refreshed, I feel at home on the courts again, and am playing as I did before, with a pure, simple and passionate love for the sport.

I have yet to face my next major test of character as an athlete, but should it come in the form of time on the bench, I will welcome the challenge. After all, some of life’s most valuable lessons aren’t necessarily learned in the thick of the action, but in the solitude of the sidelines.

Zhang Tingjun is a freelance emcee, motivational speaker and co-founder of The Chain Reaction Project. www.zhangtingjun.com

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Jeanette Wang jeanette.wang@scmp.com Fit for Fun Balance-Fruits HK$44.90 for 150 grams, Great The fruits were dried but certainly not dehydrated, with plump apricot pieces, moist banana wedges, tender dates and prunes and soft apple slices. The only negative is it uses sulphur dioxide as a preservative, which could cause reactions in those with cardiovascular or respiratory problems.

Verdict: a good pre-workout snack.

Nature’s Sensation Dried Strawberries HK$49.90 for 127 grams, Great Hailing from Thailand, this product contains no preservatives, only strawberries and sugar. The bitesized pieces had just the right moistness and sweetness, and were a pleasant chew.

Verdict: lacks the refreshing juiciness of fresh fruit, but otherwise a convenient snack.

Forest Feast Fantastic Physalis HK$19.90 for 80 grams, Great I often see the fresh version of this fruit – also known as the cape gooseberry – on cakes as decoration, and it usually isn’t very palatable.

This dried version makes it edible.

Verdict: a tad too dry and tart for my liking.

Illustration: Bay Leung