Culture

CLEVELAND, Ohio (May 29, 2019)--Although hormone therapy (HT) is the most commonly recommended treatment for menopause symptoms, research is ongoing for alternatives, especially nonpharmacologic options. Cognitive behavior therapy has previously been proposed as a low-risk treatment for hot flashes, but a new study suggests it may also effectively manage other menopause symptoms. Results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Women today have more options than ever before when it comes to the treatment of common menopause symptoms such as hot flashes, depression, sleep disturbances, and sexual function. Because of its proven effectiveness, HT still leads a long list of available treatment options. However, controversies regarding the adverse effects of HT have prompted some women to seek other options. Alternative treatments such as antidepressants have proven effective in treating menopause-related depression and, to a lesser extent, hot flashes. But these options can also have adverse effects.

Cognitive behavior therapy is a type of psychotherapy that teaches patients how to modify dysfunctional emotions, behaviors, and thoughts and to develop personal coping strategies. It has proven effective in multiple studies in the treatment of various mental health difficulties such as depression and anxiety. Previous studies relative to menopause symptoms, however, have focused only on its ability to manage hot flashes. This new study is the first of its kind to address a broad range of common physical and psychological menopause symptoms.

The study demonstrated that cognitive behavior therapy significantly improved hot flashes, depression, sleep disturbances, and sexual concerns, although little improvement was seen in anxiety. Moreover, the improvements were maintained for at least 3 months posttreatment. Although a small study, it lays the foundation for future research focused on how various psychological treatments may help the millions of women who suffer with menopause symptoms.

Findings were published in the article "Cognitive behavior therapy for menopausal symptoms: a randomized controlled trial."

"This small study is in line with other studies of menopausal women showing a benefit of cognitive behavior therapy in improving hot flashes. It additionally demonstrated an improvement in depression, sleep, and sexual function," says Dr. JoAnn Pinkerton, NAMS executive director. "Larger trials comparing cognitive behavior therapy to other active treatments will help us to better understand how effective this therapy will be in highly symptomatic women."

Chimpanzees have a mainly vegetarian diet, but do occasionally eat meat. Researchers at the University of Zurich have now shown for the first time that chimpanzees also eat crabs. In the rainforest of Guinea, the researchers observed how chimpanzees regularly fish for crabs.

"Our study is the first evidence showing that non-human apes regularly catch and eat aquatic fauna," says Kathelijne Koops, researcher at the Department of Anthropology at the University of Zurich. She and her team discovered that chimpanzees in the rainforest of the Nimba Mountains in Guinea consumed fresh-water crabs year-round. The chimpanzees searched for crabs in shal-low streams in the mountainous rainforest region by scratching and churning up the riverbed with their fingers.

The chimpanzees ate crabs irrespective of whether ripe fruit was available as an alternative. Sur-prisingly there was no correlation between the crab-fishing activity and the amount of monthly rainfall. The rate of crab-fishing also remained the same in the dry and in the rainy seasons: Even in the dry season there was enough water in the streams to provide a habitat for crabs. The chimpanzees, however, fished more often for crabs when they were eating fewer ants, which would indicate that crabs and ants have a similar nutritional value for the chimpanzees.

"Female chimpanzees and their offspring fished for crabs more often and for longer than adult males, which we had not expected," says anthropologist Koops. A possible explanation for this finding may be that crabs provide essential fatty acids, as well as micronutrients such as sodium and calcium, which are crucial for maternal and infant health.

Important for the developing brain

The findings on chimpanzees, our closest living relatives, may contribute to our understanding of why aquatic fauna became more and more important as a source of nutrition in the course of human evolution. It is thought that as long as 1.95 million years ago, hominins (ancestors of Ho-mo sapiens) consumed turtles, crocodiles and fish. It is assumed that the regular consumption of these types of aquatic fauna facilitated the growth of the developing brain in early Homo. That is because these creatures contain high amounts of polyunsaturated fatty acids, which are required for optimal brain growth and function.

"These findings on wild chimpanzees contribute to our understanding of hominin nutrition," says Kathelijne Koops. First, the findings suggest that fishing for crabs in hominins may not have been restricted to lakes, rivers or coastlines, and that those living in forest regions may have also con-sumed crabs. Second, aquatic fauna may have been a regular part of some hominins' diets and not just a seasonal fallback food. Third, the consumption of nutritionally rich crabs and other aquatic fauna may have been especially important for female hominins and their young.

CHAMPAIGN, Ill. -- A rover scanning the surface of Mars for evidence of life might want to check for rocks that look like pasta, researchers report in the journal Astrobiology.

The bacterium that controls the formation of such rocks on Earth is ancient and thrives in harsh environments that are similar to conditions on Mars, said University of Illinois geology professor Bruce Fouke, who led the new, NASA-funded study.

"It has an unusual name, Sulfurihydrogenibium yellowstonense," he said. "We just call it 'Sulfuri.'"

The bacterium belongs to a lineage that evolved prior to the oxygenation of Earth roughly 2.35 billion years ago, Fouke said. It can survive in extremely hot, fast-flowing water bubbling up from underground hot springs. It can withstand exposure to ultraviolet light and survives only in environments with extremely low oxygen levels, using sulfur and carbon dioxide as energy sources.

"Taken together, these traits make it a prime candidate for colonizing Mars and other planets," Fouke said.

And because it catalyzes the formation of crystalline rock formations that look like layers of pasta, it would be a relatively easy life form to detect on other planets, he said.

The unique shape and structure of rocks associated with Sulfuri result from its unusual lifestyle, Fouke said. In fast-flowing water, Sulfuri bacteria latch on to one another "and hang on for dear life," he said.

"They form tightly wound cables that wave like a flag that is fixed on one end," he said. The waving cables keep other microbes from attaching. Sulfuri also defends itself by oozing a slippery mucus.

"These Sulfuri cables look amazingly like fettuccine pasta, while further downstream they look more like capellini pasta," Fouke said. The researchers used sterilized pasta forks to collect their samples from Mammoth Hot Springs in Yellowstone National Park.

The team analyzed the microbial genomes, evaluated which genes were being actively translated into proteins and deciphered the organism's metabolic needs, Fouke said.

The team also looked at Sulfuri's rock-building capabilities, finding that proteins on the bacterial surface speed up the rate at which calcium carbonate - also called travertine - crystallizes in and around the cables "1 billion times faster than in any other natural environment on Earth," Fouke said. The result is the deposition of broad swaths of hardened rock with an undulating, filamentous texture.

"This should be an easy form of fossilized life for a rover to detect on other planets," Fouke said.

"If we see the deposition of this kind of extensive filamentous rock on other planets, we would know it's a fingerprint of life," Fouke said. "It's big and it's unique. No other rocks look like this. It would be definitive evidence of the presences of alien microbes."

Although pollen has covered cars for weeks and allergy sufferers have been sneezing, we think of sex as being the realm of animals. But plant sex can be quite interesting, especially in species that can have male or female flowers.

More than 90 percent of flowering plant species combine both sexes in one plant. In the less than 10 percent of species where female and male flowers exist on separate plants, they typically remain female or male throughout their lifetime. But it isn't always this simple.

In a study in the journal Annals of Botany, Rutgers University-New Brunswick researchers found that striped maple trees can change sex from year to year. A tree may be male one year and female the next, and while male trees grow more, female trees are more likely to die.

The study found that 54 percent of striped maple trees changed sexes over a four-year period, with some switching at least twice. Male trees usually outnumber female trees by more than three to one. Since the study started in 2014, 75 percent of trees that died were female. Since only female trees can make seeds, changes in the relative numbers of males and females might lead to reduced populations.

"We found that, contrary to previous scientific knowledge, unhealthy trees have a higher likelihood of being female, and the size of the tree doesn't seem to influence what sex a tree is," said lead author Jennifer Blake-Mahmud, a botanist who earned her doctorate at Rutgers and is now at Princeton University.

The striped maple (Acer pensylvanicum), a slow-growing species that reaches heights of about 30 to 50 feet, thrives at medium to high elevations along the Appalachian Mountains from Georgia to Nova Scotia, and is native to New Jersey. Although the ability for a plant to switch sex is incredibly rare, some other species are known to do so, such as the Jack-in-the-pulpit, an understory woodland plant that also flowers in the spring in New Jersey. In these cases, usually females appear to be healthier or larger since it takes more energy to be female and to produce fruits and seeds.

Understory trees like the striped maple, which grow beneath the forest canopy, can become less healthy for many reasons: insects chew on them, deer use them for antler rubs, large trees fall on them during storms or they can suffer through droughts.

Over longer periods, these stressful conditions may result in increasing numbers of females compared with males in striped maple tree populations. More females likely mean more seeds and more seedlings of striped maples. At first this might seem like a good thing, but that might not necessarily be the case. Since the female death rate is much higher than the male death rate, the number of trees in these populations may decline over the long-run.

Upcoming research will look at how important certain environmental factors may be in determining a striped maple tree's sex. The scientists are looking at the concentration of sugar stored in sap to see if trees with more sugar reserves are more likely to be female. They are also looking at whether they can trigger a sex change by causing an injury, such as cutting off a branch.

Compostable food containers seem like a great idea: They degrade into nutrient-rich organic matter, reducing waste and the need for chemical fertilizers. But much of this packaging relies on per- and polyfluoroalkyl substances (PFAS) to repel water and oil. Now, researchers reporting in ACS' Environmental Science & Technology Letters have shown that PFAS can leach from the containers into compost. However, the potential health effects of applying this material to crops are unknown.

PFAS are widely used in manufacturing because of their flame-retardant and water- and oil-repellent properties. Two long-chain PFAS, perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS), have been linked to negative health effects, so companies in the U.S. have voluntarily phased out their production. As a result, many manufacturers have switched to shorter-chain PFAS, whose health effects are less well known. Previous research has shown that PFAS in biosolids applied as fertilizer can migrate from soil to plants and then accumulate in humans through the food chain. Because compostable food packaging is becoming increasingly popular, Linda Lee and colleagues wanted to find out how much PFAS end up in the composted material.

The researchers obtained 10 samples from five states: nine from commercial facilities and one from a backyard compost bin. The researchers extracted perfluoroalkyl acids (PFAAs), which are compounds produced by microbial degradation of PFAS during composting, and analyzed them using mass spectrometry. The samples from seven facilities that accepted compostable food packaging had higher total levels of PFAAs than the two that didn't or the one from the backyard bin, which did not contain food packaging. The researchers found PFAAs corresponding to PFOA and PFOS, which are still produced in some countries, in all of the samples, but most of the detected compounds were short-chain PFAAs. The results from this study contributed to the passage in 2018 of the State of Washington's Healthy Food Packaging Act, which will ban the use of PFAS in paper food packaging after January 1, 2022, the researchers say.

The calcareous soils that pervade the southern region of the country pose a challenge for plants: though iron is abundant in the soil, plants are unable to acquire it due to the high pH levels in said soil, making iron only slightly soluble and, therefore, hard to absorb. To tackle this iron deficiency, plants activate a series of responses, such as developing new roots to span more soil or freeing protons to acidify or solubilize iron.

Depending on their needs, plants activate and deactivate these responses by means of a strictly regulated process in which hormones such as ethylene participate actively. Ethylene is also involved in other stress processes like phosphorus deficiency and pathogen attack.

With a lengthy track record of studying responses to iron deficiency that plants carry out, a research team, including Agronomy Professor Francisco Javier Romera at the University of Cordoba, has found a relationship between iron deficiency responses and the response caused by certain beneficial microorganisms, so that the latter can foster iron uptake.

Certain rhizosphere microorganisms (found in contact with the surface of the roots) cause a kind of Induced Systemic Resistance (or ISR) in plants. In other words, the plant detects a certain amount of these kinds of organisms and, perceiving them as enemies, initiates a defense strategy throughout the whole plant (systemic). However, upon perceiving that these organisms are friendly, the defense strategy is blocked but it remains ready to act systemically and rapidly once a real pathogen comes along.

The relationship that exists between this induced systemic resistance (ISR) and the responses to iron deficiency lies in the presence of the ethylene hormone in both processes. As a consequence of the common action of this hormone, proof has been found that applying these rhizosphere microorganisms so benefical to plants can induce responses to iron deficiency and hence, improve the plant's uptake of iron on land that, like calcareous land, poses quite a challenge in this context.

The challenge for the research team now lies in identifying which species of rhizosphere microorganisms are more effective for each kind of crop and under what kinds of conditions. The biggest issues with iron deficiency facing peach trees and olive trees in the area have become the main research focus for this research group. What is more, the negative effects of calcareous soils are greater in dicots (plants that have two main leaves upon germination) such as tomatoes, green beans, cucumbers and the abovementioned woody crops, meaning they will also benefit from these kinds of studies.

Researchers have combined two separate computer models to identify areas at highest risk for outbreaks of lumpy skin disease virus (LSDV) in cattle. The models could help officials determine where to send resources ahead of outbreaks and serve as a potential early warning system for cattle farmers in affected areas.

LSDV is a disease that affects cattle. Current research points to transmission via biting insects such as flies, fleas, ticks or mosquitoes. Infected calves may die, and older cattle develop bleeding circular lesions on the skin, decreased milk production, and overall poor health.

Although LSDV is endemic to Africa, since 2015 the disease has spread into the Northern Hemisphere including Azerbaijan, Kazakhstan, the Russian Federation and the Balkans. The rapid expansion of LSDV in those regions shows the virus can thrive in more temperate regions than those in which LSDV traditionally occurred.

"LSDV represents an emerging threat to international trade of livestock products and live animals, due to the economic impact of milk and beef production losses," says Gustavo Machado, assistant professor of population health and pathobiology at NC State and corresponding author of a paper describing the work. "The good news is that the disease can be controlled by vaccination. However, we need a way to efficiently target our prevention efforts."

Machado and an international team of colleagues combined two different computer models - a risk model that examined the spatiotemporal dynamics within affected areas and a suitability model that looked at ecological conditions in affected areas - to determine where the virus would be most likely to thrive. Focusing on data from 2014 to 2016, before vaccination protocols began, the team divided study areas into 20 by 20 kilometer portions and fed information on cattle numbers and ecological conditions into the integrated model.

The model identified elevated risk areas in Russia, Turkey, Serbia and Bulgaria. Risk was positively associated with precipitation and temperature, and negatively affected by wind. Results suggest that if current ecological and epidemiological conditions persist, further spread of LSDV in Eurasia may be expected.

"Although there is little risk of airborne transmission of LSDV, if ecological conditions are favorable for the insects that can transmit it, the disease can spread - even in areas where there isn't a particularly large cattle population," Machado says.

Although LSDV hasn't yet been reported in the U.S., Machado says his model could easily be used to predict high-risk areas if an outbreak occurs. "We don't want LSDV to have the devastating impact on the cattle industry that African swine fever is having on the pork industry," he says. "Models like this one are necessary to help farmers and agricultural agencies stay ahead of the disease curve."

Based on a study by McLean Hospital researchers, individuals with anxiety, depression, and other mental health conditions may soon be able to use a smartphone app to deliver on-demand cognitive bias modification for interpretation (CBM-I), a way to change mental habits without visiting a therapist.

The study, “Translating CBM-I Into Real-World Settings: Augmenting a CBT-Based Psychiatric Hospital Program,” was published in the journal Behavior Therapy. It shows the potential effectiveness of CBM-I when combined with cognitive behavior therapy (CBT) in an acute psychiatric setting. It also points the way for adapting this therapeutic approach for use outside the hospital.

The lead researcher of the study is Courtney Beard, PhD, director of McLean’s Cognition and Affect Research and Education (CARE) Laboratory.

Beard described CBM-I as a “class of interventions designed to shift people’s interpretations of ambiguous situations in either a more positive or more negative way.” She explained that “CBM-I tries to address interpretation bias, a mental habit that is implicated in many mental disorders.”

To do this, individuals undergoing CBM-I treatment can be presented with a series of word association questions that address everyday situations.

For example, the CBM-I task may show a patient a situation about a person yawning during their conversation. Then the patient is asked whether that person is “tired” or “bored.” The individual who answers “tired” is told the response is “correct,” and “bored” is incorrect. Through repetition, this type of CBM-I therapy helps the person reframe or reassess these daily ambiguous situations.

“People face countless interactions like this every day in their lives,” Beard said. “If you have a tendency to jump to a threatening or negative conclusion, it can have a huge impact on how you’re feeling and on what you do and how you react. You can get stuck in a cycle that can maintain anxiety or depression.”

For their study, Beard and her colleagues developed and implemented CBM-I to augment CBT-based treatment in a partial hospital setting. They presented patients with word-sentence associations that encouraged patients to endorse positive interpretations and reject negative interpretations.

Study results showed that CBM-I was practical and acceptable to acute psychiatric patients. Many stated that CBM-I bolstered their primary CBT-based care. The study also found that that the word association exercises were successful in helping reframe potentially negative situations.

Based on these results, Beard and her team are moving forward with a National Institute of Mental Health-backed study to develop a smartphone version of CBM-I.

“With the smartphone app, we can offer CBM-I to many more people at one time,” Beard said. “With the app, they can practice new skills, create healthy mental habits, and stop automatically jumping to negative conclusions. And they can do it on demand.”

Beard stated that the app could be particularly helpful for individuals who have just been discharged from a treatment program. “They can use it during the month transition period after they leave the hospital, which is a risky and challenging time for them,” she said.

Beard sees great promise for app-based CBM-I therapy. “It quickly shows people what their brain is doing,” she explained. “The patient sees hundreds of situations in a short amount of time. So, they see how often they jumped to a negative conclusion, and that can be very powerful. It’s kind of like cognitive therapy in your pocket—but a little different and a lot faster.”

Clinical commissioning groups (CCGs) in England are ignoring clinical guidelines by rationing access to cataract surgery,The BMJ has found.

It is the latest investigation by The BMJ to lift the lid on NHS rationing driven by financial pressures, and follows recent research which found over half of CCGs in England included cataracts in lists of treatments they deem to be of "limited clinical value."

Cataract surgery is the most common operation in the NHS, with over 400,000 procedures performed every year in the UK. Guidance from the National Institute for Health and Care Excellence (NICE) says it is cost effective and should not be restricted to more severe cases.

Yet The BMJ has gathered new evidence that patients are being screened and those not meeting visual acuity thresholds are being denied surgery.

The BMJ asked each of England's 195 CCGs how many requests for prior approval or exceptional funding they received over the past three years for cataract surgery, and how many of these requests were approved.

The analysis showed that rationing has actually increased in parts of the country since NICE's guidelines were published, with patients increasingly having to meet strict criteria before they can be referred for surgery.

Among the 185 CCGs that provided data, the investigation found that almost 2,900 prior approval or individual funding requests for cataract surgery were rejected last year, more than double the number two years ago.

And figures from the 132 CCGs that provided comparable data reveal that more than a fifth (22%) of the total number of cataract operations carried out in England in 2018-19 were screened beforehand, three times the number in 2016-17 (7%).

Mike Burdon, president of the Royal College of Ophthalmologists who also chaired NICE's guideline committee, said the criteria being applied for cataract surgery by some CCGs to control costs was a false economy. "There's a cost to the patient and the cost to society from even minor visual loss, and that's what NICE identified."

But Graham Jackson, co-chair of NHS Clinical Commissioners, points out that performing surgery is not without risk, and says a clinical threshold "is a good way of defining which patients would best be served by (in this case) cataract removal."

However, a Department of Health and Social Care spokesperson said that commissioners "should take the latest NICE guidelines into account, to ensure fair and consistent access to the best possible treatment for all cataract patients."

The BMJ's investigation also found widespread local variation in how referrals for cataract surgery are processed. For example, some CCGs require no prior approval or individual funding request to refer patients, but others process and reject hundreds of referrals in this way.

Nicholas Wilson-Holt, consultant ophthalmologist at Royal Cornwall Hospitals NHS Trust and a former member of the NICE guideline committee, said the prior approval process is "acting as a barrier and it's not in the spirit of the recommendations."

He added: "It makes people question the value of having NICE guidance, if we take a 'pick and mix' approach to which areas we adopt."

Children who spend half an hour a day outside in the sun reduce their risk of inflammatory bowel disease (IBD), according to new research from The Australian National University (ANU).

More than 800,000 people live with the two life-long disorders which make up IBD - Crohn's Disease and ulcerative colitis.

The paediatric study was based in Melbourne and led by Professor Robyn Lucas, from the ANU College of Health and Medicine.

"Taking children to play outside in the sun could be life-changing," Professor Lucas said.

"It doesn't have to be all at the same time. But, we found children who were outside and exposed to the sun for an extra half hour a day in total, had a lower risk of developing IBD by almost 20 per cent."

The researchers found even short periods of sun exposure were associated with lower risk of children developing IBD.

"We found every 10 minutes of sun exposure was associated with a lower risk of developing inflammatory bowel disease by six per cent," Professor Lucas said.

"At this stage what we have shown is there is a link between lack of sun exposure and increased risk of IBD.

"We already know that sunshine affects the immune system in ways that could decrease IBD - but we don't know the exact pathways.

"But our research suggests that getting outside and into the sunshine is a good thing when it comes to preventing this terrible disease."

Research shows Australia has one of the highest rates of inflammatory bowel disease.

"IBD is becoming more common and children are getting it at younger ages," said Professor Lucas.

"The symptoms can be awful. If you have IBD you get intermittent diarrhoea, abdominal pain, inflammation and you can feel very unwell.

"Crohn's and ulcerative colitis are horrible diseases where the autoimmune system has gone haywire and attacks the gut."

Dr Lucas says it is still important Australians remained 'sun smart' and protect themselves and their children from any potential harmful effects from the sun.

"Everyone needs a bit of sun exposure every day or at least most days of the week. But we are not talking about sunbaking or getting sunburnt," she said.

"If we can reduce the risk of developing IBD it is worth the trouble to get outdoors and get some sun - but do it safely, following Cancer Council guidelines."

An international study involving researchers from UBC Okanagan has shown that MDMA, also known as ecstasy, may be a valuable tool for treating post-traumatic stress disorder (PTSD).

Published recently in Psychopharmacology, the study demonstrated substantial improvements in individuals who had not responded to prior treatments, explains UBCO Associate Professor of psychology Zach Walsh. This is also, he adds, the most comprehensive evaluation of the safety and effectiveness of MDMA-assisted psychotherapy for PTSD.

"PTSD symptoms decreased after one session of MDMA together with psychotherapy," says Walsh, study co-author. He adds that 54 per cent of participants no longer met PTSD criteria after two sessions and that there was also improvement in their symptoms of depression.

The response of participants to MDMA-assisted psychotherapy was compared to those who received small doses or non-drug psychotherapy.

"These findings are promising and indicate the needed for larger studies," says Walsh. "Too many people with PTSD struggle to find effective treatment, and use of MDMA in a supportive environment with trained mental health professionals could be an important addition to our treatment options."

Ecstasy, also known as Molly, is the nickname for MDMA--a synthetic drug made from a combination of methylenedioxy-methamphetamine. It is a controlled, illegal drug in Canada classified as a stimulant with hallucinogenic properties.

Walsh, as well as researchers from the United States, Switzerland and Israel, examined the results from six clinical trials, involving 103 people. Trial participants included men and women with chronic, treatment-resistant PTSD from a wide variety of causes.

Based on these results, the US Food and Drug Administration granted breakthrough therapy designation to MDMA-assisted psychotherapy for PTSD, acknowledging that it "may demonstrate substantial improvement over existing therapies" and agreeing to expedite its development and review.

The first of two more in-depth clinical trials of MDMA-assisted psychotherapy for PTSD began enrolling participants in November 2018, and aims to have 100-150 volunteers across 15 sites in the US, Canada and Israel. The second trial will take place after an interim analysis of the data from the first trial, and will enrol an additional 100-150 participants. European trials are planned to start in the near future.

Nearly four per cent of all people worldwide will suffer from PTSD during their lifetime. PTSD can be a debilitating disorder, with symptoms including intrusive thoughts and memories, negative effects on thinking and mood, depression, hyperarousal and reactivity, and avoidance. People with PTSD can experience much lower quality of life and relationships, related mental health conditions and suicidal tendencies.

MIYAZAKI, JAPAN-- A Japanese study group clarified that cognitive therapy* maintained its effects more than a year after the end of therapy for patients with a social anxiety disorder (SAD) even for those who did not respond to antidepressant drugs. The study was published online in the journal Psychotherapy and Psychosomatics* on May 23, 2019.

The experiment was led by two experts on cognitive therapy in Japan, Dr. Naoki Yoshinaga, lecturer at University of Miyazaki, and Dr. Eiji Shimizu, professor at Chiba University. Since 2011, they have applied cognitive therapy, which is a Western origin psychological therapy, for patients with SAD in Japan. SAD, also known as social phobia, is a mental disorder characterized by a significant amount of anxiety or fear in social situations, such as talking in front of many people or speaking with strangers, causing considerable distress and functional disability in daily life. SAD is one of the most prevalent mental disorders, typically has early onset, and follows a chronic course because of the low natural recovery rate. SAD has caused a large social economic burden in many countries; according to the prevalence-based study in Japan, the estimate of annual economic loss exceeded 1 trillion yen (about 10 billion USD).

Although antidepressants are an effective treatment commonly used for SAD, some patients fail to remit following these drugs. However, no standard approach has been established for treating such patients. In 2016, Yoshinaga and Shimizu's study group conducted a clinical trial and reported short-term effectiveness of cognitive therapy for patients with SAD who were refractory to antidepressants (Yoshinaga et al., 2016). However, it was still unknown whether the patients could maintain cognitive therapy's effect in the long run.

In this time, they demonstrated that, in refractory patients who received 16-weeks of cognitive therapy, a substantial improvement in social anxiety symptoms occurred during the intervention period, and these improvements were well-maintained until the end of the one-year follow-up. At the one-year follow-up assessment, 85.7% (18/21) of patients were judged to be responsive to the treatment, and 57.1% (12/21) met the remission criteria.

Yoshinaga says, "People suffering from SAD could benefit not only from drug treatment but also from psychological treatment. In particular, cognitive therapy can be of help for them to overcome their problems. Even if drug treatment doesn't work, don't give up hope. Try to receive another psychological treatment, such as cognitive therapy, and continue your treatment with patience." As SAD is a hidden disorder, Shimizu added, "Unfortunately, many patients are not in treatment. SAD is more than just shyness. If you have been having severe distress, avoiding certain social situations, and thus having difficulty in your daily life due to social anxiety, it's time to seek treatment."

Yoshinaga and his Japanese group are currently working with David Clark and Graham Thew from the University of Oxford to develop a Japanese version of an internet-based cognitive therapy program for social anxiety disorder that has shown high efficacy in both the UK and Hong Kong. They are aiming to make progress towards the effective global dissemination of this treatment.

Living in a warzone is linked with an increased risk of heart attack and stroke among civilians, even years after the conflict ends, a study has found.

The findings come from the first systematic review of the effects of armed conflict on heart disease risk, carried out by researchers at Imperial College London and the London School of Hygiene & Tropical Medicine.

In the review, published in the journal Heart, the team re-analysed data from a number of studies on associations between armed conflict and the health of civilian adults of armed conflicts on civilian adults in low- and middle-income countries - including Syria, Lebanon, Bosnia, Croatia, Palestine, Colombia and Sudan.

They found that conflicts were associated with a litany of negative health outcomes for civilians, including increased risk of coronary heart disease, stroke, diabetes, increased blood pressure and cholesterol, as well as increased alcohol and tobacco use.

Beyond the immediate impacts of conflict, such as blast injuries, infectious diseases or malnutrition, the researchers cite longer-lasting health risks for civilians which may be due to multiple factors, including disruptions to healthcare services, putting them at greater risk of heart disease in the medium to long term.

The team say the findings could help inform international health policy in the prevention of heart disease in politically unstable countries where conflict is taking place, or likely to occur. They also offer recommendations, including prioritising primary healthcare during and after conflicts and training healthcare professionals to focus on both the cheapest and effective ways to prevent heart disease, such as prescribing generic medicines instead of branded ones and helping people to quit smoking.

"This is the first review of its kind to examine the links between armed conflict and the risk of heart disease among civilians" said first author of the study, Dr Mohammed Jawad, from Imperial's School of Public Health. "Because of the nature of war, data is often scarce and patchy, but our study shows evidence of a link between armed conflicts and increased deaths from heart disease and stroke."

In the latest review, the team carried out a literature search, trawling science publication libraries to look at a total of 65 studies incorporating 23 armed conflicts. The studies included in the review focused on cardiovascular disease and its risk factors. Along with figures for prevalence and death rates, they also reviewed study data on cholesterol levels and blood pressure - as well as behavioural data on alcohol and tobacco consumption.

In one example, researchers included studies looking at the causes of death before and after the 2003 US-led invasion of Iraq. Data collected from household surveys showed the rate of deaths from heart attack or stroke increased significantly, from 147.9 per 100,000 people before the invasion to 228.8 per 100,000 post-invasion. In a similar study, heart disease was the principal cause of about half of non-violent deaths during the US-led invasion of Iraq.

The review was unable to identify clear mechanisms underlying the findings, but these are likely to be complex and numerous.

According to the researchers armed conflict could potentially impact chronic health conditions through two main mechanisms: Firstly, the direct effects of living in a conflict zone itself can increase stress and anxiety, leading to higher blood pressure, as well as worsening risk behaviours such as drinking more alcohol and smoking more.

Second, the destruction of healthcare systems can eliminate screening programmes, reduce patient access to working hospitals and healthcare staff, reduce the availability of medicines and make taking regular medications - such as statins or insulin - a lower priority for people facing conflict.

Professor Christopher Millett, a Professor of Public Health at Imperial and senior author of the paper, said: "The experience of armed conflict, be it specific traumatic events or displacement from your home, appears to place civilian populations at greater risk of increased blood pressure, alcohol use and smoking, which are established risk factors for heart disease. Even if civilians are willing and able to seek healthcare services during armed conflict, access is often limited due to hospital closures, road blockades, lack of available medications, and more."

Overall, they found evidence that conflict is associated with increased coronary heart disease, cerebrovascular disease (stroke) and endocrine disease (such as diabetes). There was also evidence of increased alcohol and tobacco consumption, during and after conflict.

The researchers suggest that community-based healthcare models (where people access services through GP clinics) may be best positioned to deliver interventions, such as screening for underlying health conditions, prescribing preventative medicines (such as statins) or offering smoking cessation and alcohol reduction programmes, in conflict and post-conflict situations. They add that training healthcare professionals in affected regions should be a priority, enabling them to deliver cardiovascular disease prevention and control measures once a conflict has ended.

Dr Jawad highlights that the findings are limited, with two-thirds of the 65 included studies being of 'low quality', and that this may be in part due to the nature of data collection during times of conflict - with civilians and health services failing to register deaths, or their causes. However, study findings were largely consistent when the researchers restricted their analysis to higher quality studies. They add that evidence for links between armed conflict and other health outcomes is lacking, but more, better-designed studies could help.

The review also found a number of gaps in the literature, including a lack of studies from the Middle East, or about refugees. Refugees in particular are exposed to a "double burden" - the impact of the armed conflict itself, and the impact of forced migration following armed conflict, so a better understanding of how wars affect their risk of different diseases is important.

Dr Jawad added: "As conflicts are becoming increasingly protracted, this brings new challenges for measuring the impact on public health. There is an urgent need for more research in this area to confirm the associations we found, and to help governments and health agencies reduce the burden of heart disease among civilians during and in the months and years following wars."

The "loser effect" - which causes animals to shy away from violence after losing a fight - evolves independently of any change in fighting ability, new research suggests.

Scientists studied male broad-horned flour beetles, which regularly fight over females, to see how long they avoided fights after a defeat.

Most would not start a fight for about four days after a loss, but researchers from the University of Exeter, Okayama University and Tokyo Metropolitan University selectively bred the beetles for a shorter duration of this loser effect and found that it evolved to be shorter - despite no improvement in fighting prowess.

"Theory predicts that the loser effect should evolve independently of actual fighting ability, but previous tests of this have been limited," said Professor David Hosken, of the Centre for Ecology and Conservation on Exeter's Penryn Campus in Cornwall.

"By selecting males who experienced the loser effect for the shortest time, we were able to breed beetles willing to fight again sooner.

"It is fascinating that these males were no better at fighting. In other words, there is a complete disconnect between actual fighting ability and the duration of the loser effect."

The study, of captive-bred beetles in Japan, paired males of similar sizes and let them interact for an hour, after which a male that had pushed and chased his opponent was recorded as the "winner".

After ten generations, beetles selectively bred for a reduced loser effect returned to pre-defeat levels of aggression and fighting success after three days instead of four.

"It make sense for animals to use past experience to decide whether to engage in a behaviour," said Associate Professor Kensuke Okada, of Okayama University.

"Losing a fight is a useful clue of the likely benefits of further fighting for a particular individual.

"Some species also show a 'winner effect' - being more willing to fight after a victory - but that is not the case among broad-horned flour beetles."

Financial education often stresses the importance of earning and saving, but new research suggests that one of the most valuable lessons parents can teach their children about money might be how to appropriately give it away.

The study, led by University of Arizona researcher Ashley LeBaron and published in the Journal of Family and Economic Issues, explores how financial-giving habits are passed down through generations, and how early life lessons in giving may contribute to personal and financial well-being later on.

Existing research has established that children learn more about finances from their parents than any other source. In previous work, LeBaron highlighted how important it is for parents to give their children hands-on experience with money, in addition to having discussions with them about money and presenting a good financial example.

LeBaron's new study suggests that hands-on experience with giving may be particularly important.

LeBaron and her collaborators interviewed 115 participants, including college students, parents and grandparents, about what they learned about money from their parents. The parent and grandparent participants also were asked what they taught their children about the topic, ultimately providing researchers a picture of how financial lessons are shared across four generations.

Participants were not asked to talk about financial giving directly, yet nearly 83 percent of them brought it up as an important part of the financial education they gave or received.

"When you think about money and what kids learn about money from their parents, most of us wouldn't think about giving as one of the basic principles of finance," said LeBaron, a doctoral student in the Norton School of Family and Consumer Sciences in the UA College of Agriculture and Life Sciences. "We tend to think more in terms of budgeting and saving and things like that, so it was surprising, but really cool, to see that giving was so prevalent."

Participants described different motivations for teaching their children about giving, including a sense a religious duty, a desire to help others and a desire to give back. They generally talked about three different types of giving:

Charitable donations. This encompasses monetary gifts to religious or charitable organizations.
Acts of kindness. This includes donations, gifts or acts of service provided more directly to people in need. Examples might include providing meals for homeless individuals or purchasing Christmas gifts for neighboring families in need.
Investments in family. This category encompasses financial decisions made by parents to benefit their children or family. For example, some parents might make financial sacrifices in order to enroll a child in sports or music lessons, or to plan a family vacation.

Teaching kids to give is important for a couple of reasons, LeBaron said.

From a practical standpoint, it can be a good way for kids to learn financial basics, like budgeting and saving. For example, some study participants talked about having money jars from a young age, with one jar dedicated to money they would save, another for money they would spend and one for money they would give.

"If a certain percentage of your money goes toward giving, that's the start of a budget right there," LeBaron said.

Lessons in giving may also help set the stage for a happier, healthier future.

"People who are generous tend to be happier and have healthier relationships, so this is shaping not only kids' finances but aspects of their health and well-being," LeBaron said.

Parents who already make it a habit to give financially should make it a point to let their children witness that behavior, LeBaron said. Or even better, they should consider involving their children directly in giving activities.

LeBaron and her colleagues also found that just as parents can influence their kids' financial behaviors, so, too, can kids influence their parents.

"Parents and grandparents report that they have this awareness that their kids are learning financial attitudes and values from them, so sometimes they were more giving because they knew that their children were watching them, and they wanted to set that good example," she said.

LeBaron said she was inspired by how many people in the study stressed the importance of giving and caring for others. She said it could have implications for not only how parents talk to their kids about money, but also how educators discuss the topic.

"In finance classes, we never talk about giving," LeBaron said. "But we learned that giving is maybe one of the more important facets of financial socialization, so we need to be paying more attention to how it is taught."