Relieving the cost of COVID-19 by Parrondo’s paradox

The outbreak of coronavirus disease 2019 (COVID-19) has spread rapidly across the globe at an alarming pace, causing considerable anxiety and fear among the general public. In response to the growing number of new cases, many countries have imposed lockdown measures to slow the spread of coronavirus. However, nearly every individual, community, business, and economy has been adversely affected by lockdown measures—an impact to society that cannot be ignored.

The health and well-being of the population will be affected if the community is kept open, but the lockdown strategy also incurs economic and financial impacts. Each strategy on its own will increase the total ‘cost’ to society. Can both losing strategies be combined in a manner that leads to a winning outcome? That is the question that researchers from the Singapore University of Technology and Design (SUTD) set out to answer in a recent paper published in Advanced Science.

The team, led by Assistant Professor Kang Hao Cheong from SUTD, seeks to answer this question by modeling the population using Parrondo’s paradox with a view to relieve the cost of the epidemic by means of a switching strategy. The model takes into account the health and well-being of the population, as well as economic impacts and describes the interaction and flow between the different population compartments during the COVID-19 epidemic.

The researchers were inspired by a phenomenon called Parrondo’s paradox. The paradox states that it is possible to alternate between a pair of losing strategies and still end up winning. Their results represent one of the first studies to focus on the lockdown exit strategy. It is also one of the first to link Parrondo’s paradox to epidemiology.

From this study, the researchers show that keeping the community open results in a large number of infected individuals and a sharp increase in the number of deaths over time, so naturally the ‘cost’ increases. At the same time, a lockdown strategy reduces the possibility of infection, but has an adverse effect on the socio-economic cost.

“This means that each strategy cannot individually result in a decline to the ‘cost’ in the long-term during an epidemic. Such rising ‘cost’ allows us to classify them as losing strategies,” explained Tao Wen, a research student from SUTD and a co-author of the study.

“When one switches between the losing strategies in accordance with any of the proposed alternating strategies, the ‘cost’ per day will decline. This, in itself, is a winning strategy to control the loss caused by COVID-19,” he added.

This is a manifestation of the game theory Parrondo’s paradox: two losing strategies can be combined into an outcome that wins.

The researchers have introduced three different switching rules. They are the time-based switching, result-based switching, and random switching schemes. Each switching rule comes with its own strengths and is applicable across a wide range of real-world scenarios.

“Such novel strategies can be implemented to curb the spread of COVID-19 or future epidemics, and have the potential to alleviate suffering, preserve and promote health and well-being among the population,” observed Assistant Professor Kang Hao Cheong, the principal investigator for this study from SUTD.

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US hoping for two Covid-19 vaccines by end of November

Two American companies expect to apply for emergency approval for their COVID-19 vaccines by late November, welcome news as the US hits a third surge of its coronavirus epidemic and approaches its eight millionth case.

Pfizer said Friday it hopes to move ahead with its vaccine after safety data is available in the third week of November, a couple of weeks after the November 3 presidential election.

The announcement means the United States could have two vaccines ready by the end of the year, with Massachusetts biotech firm Moderna aiming for November 25 to seek authorization.

“So let me be clear, assuming positive data, Pfizer will apply for Emergency Authorization Use in the US soon after the safety milestone is achieved in the third week of November,” the company’s chairman and CEO Albert Bourla said in an open letter. The news lifted the company’s shares two percent in the US.

But experts warn that even when vaccines are approved, it will take many months until they are widely available.

In any case, they are unlikely to be a good substitute for mask wearing, social distancing and other recommended behavior to curb transmission because we don’t know how effective they will be.

Indoor gatherings in colder weather

After falling numbers throughout the summer, the country hit an inflection point in its coronavirus outbreak around the second week of September—with a new daily case average of more than 50,000 according to the latest figures, and the trajectory is upward.

With a shade under eight million confirmed infections and more than 217,000 deaths, America is the hardest-hit country in the world.

The US never came close to returning to its baseline after its first wave in spring, meaning the current spike can be more accurately termed a third surge.

Geographically, the major hotspots are in the Upper Midwest and parts of the Rocky Mountains in the west, while parts of the Northeast that were hit hard in spring are seeing their outbreaks starting to rekindle.

Harvard surgeon and health policy researcher Thomas Tsai told AFP there were multiple factors behind the rising cases—from under testing in the Midwest to authorities failing to monitor the reopening of bars and restaurants and dialing back when necessary.

What’s more, “from the contact tracing reports from various municipalities and states, the worry is that the spread is driven now, by indoor social gatherings in people’s homes,” he added, as the focus of social life shifts from public to private spaces in the colder weather.

One bright sign is that COVID-19 treatments have improved markedly, and since the cases are more spread out than before, hospitals aren’t being overwhelmed.

Widespread mask use might also mean that when people do get infected, they have less virus in their body which makes them less sick.

‘No magic bullet’

While vaccines are a crucial tool against the virus, experts have warned they can’t be a substitute for behavioral measures like masks and distancing.

“It’s welcome news that there will be one more thing that can help prevent COVID transmission,” said Priya Sampathkumar, an infectious disease doctor and professor at Mayo Clinic.

“But I think we need to be cautious and understand that a vaccine isn’t a magic bullet,” she added.

Pfizer and Moderna, both funded by the US government, launched Phase 3 of their clinical trials at the end of July, and both were producing their doses at the same time.

They aim to deliver tens of millions of doses in the US by the end of the year.

Both are “mRNA vaccines,” an experimental new platform that has never before been fully approved.

They both inject people with the genetic material necessary to grow the “spike protein” of SARS-CoV-2 inside their own cells, thus eliciting an immune response the body will remember when it encounters the real virus.

This effectively turns a person’s own body into a vaccine factory, avoiding the costly and difficult processes that more traditional vaccine production requires.

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Drug tricks cancer cells by impersonating a virus

A new cancer drug helps the immune system destroy tumors by impersonating a virus and “infecting” cancer cells.

The drug, called BO-112, is in human trials and mimics the structure of a double-stranded RNA molecule, a type of genetic material found in some viruses. Viruses inject their RNA into cells during infection, but cells can spot this viral RNA using specific receptors, and call upon the immune system to intervene when viruses strike.

BO-112 takes advantage of this cellular defense mechanism — once injected inside a tumor, the drug helps to alert the body’s immune system to the cancer’s presence. To hide from the immune system, cancer cells often cloak themselves in disguises, and also stop signals that could alert the body of their location. But when treated with BO-112, tumors throw up red flags that the immune system can spot.

The drug, which has been tested in mice and a a few dozen people, could help amplify the effects of existing cancer treatments designed to rally the immune system, study author Dr. Anusha Kalbasi, an assistant professor of radiation oncology at the University of California, Los Angeles and member of the UCLA Jonsson Cancer Center, told Live Science in an email. 

In other words, once BO-112 reveals the location of a tumor, other treatments could more easily target it. “I do think the power of BO-112 is in its ability to enable other immunotherapies to maximize their benefit,” Kalbasi said. 

In a new study, published Oct. 14 in the journal Science Translational Medicine, Kalbasi and his colleagues tested BO-112 in lab dish experiments and a mouse model of melanoma, a kind of skin cancer. In a separate clinical trial, published the same day, 44 human patients took BO-112 with and without additional cancer treatments, so researchers could begin to analyze how safe and effective the drug is in people. The early results hint that BO-112 can make tough-to-treat tumors vulnerable to immunotherapy, but the team now needs to confirm that those results hold up in larger groups. 

Unmasking cancer cells 

Cancer immunotherapy works by ramping up the body’s immune defense against tumors, but cancer cells use various tricks to resist these attacks. 

For instance, an immunotherapy called “adoptive T cell therapy” involves extracting a patient’s immune cells, modifying them to better recognize specific tumors and then reintroducing them to the body, according to a statement. These T cells detect tumors by scanning for specific molecules on their surfaces, called antigens — but some tumors can slow or stop production of these antigens, or prevent them from being displayed on a cell’s surface, thanks to specific genetic mutations, making them effectively invisible to T cells.

In theory, forcing such tumors to build and present antigens on their surface would make them visible to T cells; Kalbasi and his colleagues tested this idea in several mouse studies.

They first engineered mouse tumor cells with mutations that would reduce the number of antigens on their surfaces. In lab dish studies, the mutant tumor cells could not be detected by T cells.   

But when the team turned on a gene called NLRC5 in the engineered tumors, the cells generated antigens in spite of the other mutations they’d introduced. Activating this gene made the tumor cells visible to T cells, leaving the cancer open to attack. The same strategy worked when the team moved from lab dishes to actual lab mice; however, for the same approach to work in humans, scientists would need to somehow turn on the NLRC5 gene in a patient’s tumor cells. 

To achieve the same result more practically, the team turned to BO-112. Similar to NLRC5, the drug makes cancer cells produce antigens; rather than switching on a specific gene, the drug instead tricks the tumor into reacting as if it’s being infected by a virus.

Without an injection of BO-112, the lab mice’s tumors did not succumb to adoptive T cell therapy, because the T cells could not detect the tumors in the first place. However, after the injection, the T cell treatment suddenly worked, Kalbasi said.

“When we added BO-112, the tumors either decreased in size or stopped growing for a period of time,” he said.

From mice to humans

However, in mice with large tumors, the cancer eventually began to grow again, Kalbasi noted. In mice with small tumors, the combinatory treatment was more effective, as the tumors shrunk more dramatically in size and sometimes disappeared altogether, he said.

To probe whether B0-112 works in human patients as it does in mice, another group of researchers conducted a small clinical trial, sponsored by the pharmaceutical company Highlight Therapeutics. Most of the patients handled the treatment well, although three of the 44 participants experienced a severe reaction, including lung inflammation and a significant drop in platelet levels, which are important for blood clotting, according to the report. 

Of the 44 patients, 28 patients who did not experience these side effects received injections of B0-112 along with existing immunotherapy drugs, called nivolumab and pembrolizumab. These treatments “remove the brakes off the body’s T cells” so they can target tumors more effectively, Kalbasi said. In the clinical trial, BO-112 made tumors more sensitive to these two drugs; after eight to 12 weeks of treatment, 10 patients with metastatic cancer reached “stable disease,” meaning their tumors had stopped growing, while the tumors of three other patients actually began to shrink. 

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That said, “the number of patients is too low to draw a formal conclusion about the responses because the main objective of this first in-human clinical trial was safety,” the authors wrote. However, these early results hint that BO-112 could be an effective strategy to take down tumors that are resistant to immunotherapy, they noted.

“Every cell type has a different capacity to sense double-stranded RNA,” the molecule that BO-112 mimics, Kalbasi added. “So we will be watching carefully to learn what factors in each patient may predict a better response to BO-112,” since some cancers might be more sensitive to the treatment than others. Given that BO-112 is currently administered as a direct injection into tumors, initial trials will likely focus on cancer types with “superficially accessible” tumors, such as melanoma, lymphoma, breast cancer and bladder cancer, said Dr. Joshua Brody, director of the Lymphoma Immunotherapy Program at the Icahn School of Medicine at Mount Sinai, who was not involved in the study.

“The exciting opportunity presented by these two studies, both in the lab and in patients, is that we have medicines that can improve antigen presentation and thereby make immunotherapies — which would otherwise fail — become effective in inducing cancer remissions,” Brody told Live Science in an email.

Originally published on Live Science. 

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Study identifies brain cells most affected by epilepsy and new targets for their treatment

Epilepsy is one of the most common neurological diseases. It is caused by a malfunction in brain cells and is usually treated with medicines that control or counteract the seizures.

Scientists from the Faculty of Health and Medical Sciences, University of Copenhagen and Rigshospitalet have now identified the exact neurons that are most affected by epilepsy. Some of which have never been linked to epilepsy before. The newfound neurons might contribute to epileptogenesis—the process by which a normal brain develops epilepsy—and could therefore be ideal treatment targets.

“Our findings potentially allows for the development of entirely new therapeutic approaches tailored towards specific neurons, which are malfunctioning in cases of epilepsy. This could be a breakthrough in personalized medicine-based treatment of patients suffering from epileptic seizures,” says Associate Professor Konstantin Khodosevich from Biotech Research & Innovation Center (BRIC), Faculty of Health and Medical Sciences.

A major step towards more effective drugs

It is the first time a study investigates how every single neuron in the epileptic zone of the human brain is affected by epilepsy. The researchers have analyzed more than 117,000 neurons, which makes it the largest single cell dataset for a brain disorder published so far.

Neurons have been isolated from tissue resected from patients being operated as part of the Danish Epilepsy Surgery Programme at Rigshospitalet in Copenhagen.

“These patients continue to have seizures despite the best possible combination of anti-seizure drugs. Unfortunately, this is the case for 30-40% of epilepsy patients. Active epilepsy imposes serious physical, cognitive, psychiatric and social consequences on patients and families. A more precise understanding of the cellular mechanism behind epilepsy could be a major step forward for developing drugs specifically directed against the epileptogenic process compared to the current mode of action reducing neuronal excitability in general throughout the brain’ says associate professor Lars Pinborg, head of the Danish Epilepsy Surgery Program at Rigshospitalet.

From ‘neuronal soup’ to single cell analysis

The study from the Khodosevich Group differs from previous work by using single cell analysis. Earlier studies on neuronal behavior in regards to epilepsy have taken a piece of the human brain and investigated all the neurons together as a group or a ‘neuronal soup.” When using this approach, diseased cells and healthy cells are mixed together, which makes it impossible to identify potential treatment targets.

“By splitting the neurons into many thousands of single cells, we can analyze each of them separately. From this huge number of single cells, we can pinpoint exactly what neurons are affected by epilepsy. We can even make a scale from least to most affected, which means that we can identify the molecules with the most promising potential to be effective therapeutic targets,” says Khodosevich.

Next step is to study the identified neurons and how their functional changes contribute to epileptic seizures. The hope is to then find molecules that can restore epilepsy related neuronal function back to normal and inhibit seizure generation.

Expanding knowledge on underlying mechanisms of epilepsy

The study confirms expression from key genes known from a number of previous studies, but is also a dramatic expansion of knowledge on the subject. Previously, gene expression studies have identified a couple of hundred genes that changes in epilepsy.

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Battered by 1st wave, Madrid hospital staff blench at 2nd

With speed and determination, nurses, doctors and caretakers move in and out of glassed rooms with beds hooked up to tubes, cables and monitors. The cadence of beeps serves as a soundtrack to their workday, underpinned by a constant chatter of voices at half pitch and the snapping of rubber gloves as they’re removed by staff ending their shifts.

It’s another day at the intensive care ward at the Torrejón de Ardoz University Hospital, on the outskirts of the European capital that has so far seen the worst of the second wave of the pandemic. Still, hospital staff count themselves lucky: Despite having had to add nine intensive care beds to the usual 16, the hospital hasn’t had to postpone treatment for any other patients.

Many others in the region have.

Hospitals and their workers have been stretched to their limits again in Madrid, where the surging number of COVID-19 patients in September forced an expansion of critical care beds into gymnasiums and surgery rooms. But as the number of incoming patients started to ease last week, health professionals are dismayed at what they see as official acceptance of a situation that is far from normal.

“It can’t be that we fall into a dynamic of a virus wave followed by a lockdown, and then the next wave in winter and lockdown again in winter,” said Carlos Velayos, an intensivist who has seen a slight decrease in new patients with coronavirus-related symptoms arriving at his Fuenlabrada hospital, also in suburban Madrid.

At the peak of the first wave, ICU wards were given over to haste, desperation and even cluelessness about what to do. Now, a well-oiled machinery saves some lives and loses others to COVID-19, but without the doomsday atmosphere of March and April.

“It’s no longer like being in a war zone field hospital,” said Velayos. “But the reality is that we are working way over our normal capacity. This is a situation that is absolutely exceptional and that we shouldn’t have reached under any scenario.”

As many professionals are still coming to terms with the emotional impact of the first wave, they are now struggling to understand why Spain has not prepared better for new outbreaks of a virus that has left more than 825,000 infected in the country and at least 32,000 deaths.

Treatment has improved, although the time that COVID-19 patients spend under intensive care can still stretch for weeks or even months, taking up desperately-needed hospital resources, said Dr. María José García Navarro, medical director of the Torrejón de Ardoz University Hospital, where 49 patients are now being treated, 35 in normal beds and 14 in ICUs.

“We have learned to quickly identify the symptoms and what treatment to apply, which are the drugs that are useful and which aren’t, even if that narrowed down our options,” García Navarro said. Corticosteroids that were experimented with at the onset of the pandemic have now discarded on behalf of Remdesivir, the drug that has yielded better results so far.

With more experience, García Navarro and her team have been able to fine-tune the timings of when to apply medication and treatments. They have learned, for example, that the sooner patients with respiratory problems are sent into intensive care treatment, the more chances they have of surviving.

Although official statistics in Spain show that the speed of new confirmed infections is waning —the two-week infection rate per 100,000 inhabitants has come down from the second-wave peak of 294 cases on Sept. 29 to 273 on Tuesday— officials and experts warn against complacency. Seven months into the pandemic, the country hasn’t streamlined the reporting of Covid statistics.

Nationally, hospital admissions have kept increasing, slowly but steadily. According to the latest available official data, over 9% of normal beds and more than 17% of intensive care unit beds are devoted to treating COVID-19 patients at the national level, although the situation is far worse in the most affected areas.

In Madrid, officials say that over 40’% of the region’s ICU capacity is now being used to treat COVID-19, but health workers pooling data from all the region strongly dispute that. With more than 500 gravely-ill patients as of Tuesday, they say they are working at 30% over the normal ICU capacity in public facilities.

Dr. César Carballo, an emergencies physician with the Ramón y Cajal Hospital in Madrid, says Spanish politicians have been slow in reacting to new outbreaks ever since anti-coronavirus restrictions were dropped as soon as the first wave was tamed.







“In Madrid there has been no real action until the data on hospital and ICU admissions told us how dire the situation was, but that should be the last-resort indicator that we should had been looking at,” Carballo said at an online discussion with colleagues on Tuesday.

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Giving HPV vaccine to girls 'cuts risk of cervical cancer by 88%'

Giving the HPV vaccine to schoolgirls slashes their risk of getting cervical cancer by 88%, major study claims

  • The Swedish study is the biggest one to evaluate the success of the vaccine 
  • They tracked 1.7million women over 11 years — around a third had had the jab
  • Rates of cervical cancer were lower in women vaccinated before the age of 17 

Giving the HPV vaccine to schoolgirls slashes cervical cancer rates by 88 per cent, a study has revealed.

In the biggest study yet to evaluate the success of the vaccine, experts followed 1.7million women over 11 years, including half a million who received the jab.

They found that rates of cervical cancer were 88 per cent lower in women who were vaccinated before the age of 17, and 50 per cent lower in older women who had been immunised.

The HPV vaccine prevents infection from human papillomavirus, a common group of viruses that are behind 90 per cent of cases of cervical cancer.

In the biggest study yet to evaluate the success of the vaccine, experts followed 1.7million women over 11 years, including half a million who received the jab

It has been given to teenage girls in UK since 2008, and was last year made available to schoolboys at the age of 12 and 13 for the first time.

Currently 3,200 cases of cervical cancer are diagnosed every year in Britain, leading to more than two deaths a day.

But this research suggests cervical cancer cases will drop sharply over the next few years as more and more people are vaccinated, with experts hopeful the disease could eventually be eliminated.

Co-author Professor Pär Sparén, from the Department of Medical Epidemiology at the Karolinska Institutet in Sweden, said: ‘Girls vaccinated at a young age seem to be more protected, probably because they are less likely to have been exposed to HPV infection and given that HPV vaccination has no therapeutic effect against a pre-existing infection.

‘Our study shows that HPV vaccination may significantly reduce the risk of cervical cancer, especially if completed at an early age.

‘Our data strongly supports continuing HPV vaccinations of children and adolescents through national vaccination programs.’ 

Of the 1.7million women included in the study, just 19 vaccinated women were diagnosed with cervical cancer compared to 538 unvaccinated women.

Robert Music, chief executive of Jo’s Cervical Cancer Trust, said: ‘The HPV vaccine is an important tool in the fight against cervical cancer. 

‘Sadly Covid-19 has disrupted many vaccination programmes and led to increased vaccine hesitancy. 

‘We must ensure those eligible do not miss out on the opportunity to reduce their cervical cancer risk and communicating the benefits of the vaccine is essential. 

‘For countries without a HPV vaccination programme, this data should help to demonstrate the impact it could bring.’ 

The research was published New England Journal of Medicine. 

WHAT IS HPV? THE INFECTION LINKED TO 99% OF CERVICAL CANCER CASES

Up to eight out of 10 people will be infected with HPV in their lives

Human papilloma virus (HPV) is the name for a group of viruses that affect your skin and the moist membranes lining your body. 

Spread through vaginal, anal and oral sex and skin-to-skin contact between genitals, it is extremely common. 

Up to eight out of 10 people will be infected with the virus at some point in their lives.

There are more than 100 types of HPV. Around 30 of which can affect the genital area. Genital HPV infections are common and highly contagious.

Many people never show symptoms, as they can arise years after infection, and the majority of cases go away without treatment.

It can lead to genital warts, and is also known to cause cervical cancer by creating an abnormal tissue growth.

Annually, an average of 38,000 cases of HPV-related cancers are diagnosed in the US, 3,100 cases of cervical cancer in the UK and around 2,000 other cancers in men.

What others cancers does it cause? 

  • Throat
  • Neck
  • Tongue
  • Tonsils
  • Vulva
  • Vagina
  • Penis
  • Anus

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Woman loses four stone by swapping takeaways for home-made healthier fakeaways

Like so many of us, Lucy Robathan, 20, piled on weight after getting into a relationship.

At her heaviest she weighed 15 stone, thanks to curling up on the sofa and ordering a takeaway with her new man every night.

But after realising that none of her clothes fit, Lucy decided to make a change.

She managed to lose four stone and completely transform her body by making one simple change: ditching the takeaways and making her own healthier fakeaway versions at home.

By making her own pizza wraps, vegan kebabs, and McMuffin dupes, Lucy soon saw the weight fall off, and is now just 11 stone.

Lucy, from Hinckley, Leicestershire, said: ‘I have always felt uncomfortable with my body but I never had the motivation to do anything about it.


‘I was bullied when I was younger for my weight but as you get older it stops.

‘I was very uncomfortable going out with my boyfriend, because he was so fit.

‘When I got into a relationship I gained almost two stone- I realised we would order takeaways on most days or go out for meals.

‘I used to get fizzy drinks every day and binge junk food-I didn’t really think about what I was eating.

‘I found Instagram accounts and started calorie counting and making fakeaways.

‘It was more of a lifestyle change for me rather than a diet, I didn’t feel restricted at all.’

Lucy’s fakeways included a 258 calorie kebab, a 307 calorie McMuffin fakeaway made with quorn sausage patties, and 250 calorie pizza wraps.

Lucy’s diet before and after:

BEFORE

  • Breakfast: bacon or sausage baguette
  • Lunch: pizza
  • Dinner: takeout
  • Snacks: chocolate and crisps
  • Drinks: fizzy drinks

AFTER

  • Breakfast: overnight oats or eggs on toast
  • Lunch: homemade pizza wraps
  • Dinner: fakeaways
  • Snacks: low cal bars, fruits, boiled eggs
  • Drinks: water


Along with tweaking her diet, Lucy, who shares her journey on Instagram, also started doing weight training four times a week.

Her advice to others hoping to lose weight is to go slow and steady rather than doing crash diets and expecting instant results.

‘It took me almost two years to get where I am right now, weight loss needs patience,’ Lucy said.



‘I had a lot of people telling me I look great, ask me how I’ve done it and if I can share any tips.

‘My advice for people trying to lose weight would be that it takes time, it doesn’t happen overnight, don’t be too restrictive.

‘I think it’s important to keep a balance, don’t limit yourself too much and don’t stop socialising because you are on diet.’

Do you have a story to share?

Get in touch by emailing [email protected]

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Kids Often Hit Hard by Death of Beloved Pet, Study Finds

WEDNESDAY, Sept. 23, 2020 — The loss of a pet may be a child’s first encounter with death, and new research suggests no one should underestimate the psychological trauma that the loss can bring.

Previous studies have found that kids form deep emotional attachments to their pets and having a furry companion in your youth has been linked to greater empathy, self-esteem and social skills.

“The effects of pet loss were unique,” said study co-author Erin Dunn, an assistant professor of psychiatry at the Center for Genomic Medicine at Massachusetts General Hospital in Boston.

To learn more, she and her hospital colleagues looked at a sample of more than 6,000 British children. Almost 9 out of 10 had owned a pet during their youth, and more than half had lost one during their first seven years of life.

Information was collected as a part a long-term study of parents and kids in Britain. When kids were 8 years old, their mothers filled out questionnaires about their youngsters’ mental health symptoms.

“For example, how often does your child feel sad, depressed or anxious — these are the kind of emotional and behavioral indicators that are used to identify and characterize children who might be experiencing some mental health-related challenges,” said Dunn.

The research team found that kids who lost a pet were more likely to have poor mental health. And the link held true after accounting for other distressing factors, including financial hardship, parental physical or emotional abuse, and physical or sexual abuse by anyone.

While a child’s mental well-being can be affected by many other adversities, the effects of pet loss “were not explained by these other hardships,” Dunn said.

And boys seemed to be affected more deeply than girls, the study found.

“The boys had more psychopathology symptoms — or a greater effect of the pet death, as compared to their female counterparts,” said co-author Katherine Crawford, who worked on the study while at Massachusetts General Hospital. She’s now a genetic counselor at Women & Infants Hospital of Rhode Island in Providence.

Crawford added that the questionnaire used to evaluate well-being does not serve as a definitive diagnosis of any mental health disorder. But, she said, it asks “a lot of the same questions that one might when evaluating those mental health concerns.”

While the study did not examine how best to help a child cope with losing a furry friend, researchers suggested that being aware and recognizing a child’s emotions is a good start.

George Holden is chairman of the psychology department at Southern Methodist University in Dallas. He advised parents to talk frankly with their children regarding the loss of a pet.

“All too often parents think, erroneously, that if they don’t mention something, it’s better — it will go away,” said Holden, who wasn’t part of the study. “That’s absolutely wrong. It’s much better to directly recognize what’s going on, talk about it, and hear the child’s perspective.”

He also suggested being proactive and preparing a child for the inevitable if a pet is old or sick.

Struggling with the loss of a pet is entirely normal, Holden added, as they are often very well-loved family members.

Despite the emotional toll of losing a pet, researchers are not suggesting that parents avoid getting one.

Dunn suggested that further research should explore the “positive benefits of pet ownership because that kind of information would help parents in weighing the cost-benefit ratio of having pets.”

The findings were recently published online in the journal European Child & Adolescent Psychiatry.

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Need a pep talk? Here are ten rules to live by if you want to make a change

Sometimes in life all we need is someone to sit us down, give us a good talking to and offer some advice.

Whether it’s motivation to workout, reasons to change career, how to overcome adversity or to boost your confidence, talking to someone who has ‘been there and done that’ can have a hugely positive impact on your own life.

PepTalk is a new online coaching platform that allows you to connect with people such as entrepreneurs, industry experts, award-winning adventurers and gold-medal athletes.

The aim is to motivate, educate and inspire you to be bigger and better than you were before.

We’ve asked ten of their experts to share the rules they live by, in order to lead a healthier and happier life.

Rule 1: When making changes, understand why

‘I encourage moderation and understanding when making lifestyle changes,’ says Marina Kirik, stress buster, joy finder and meditation coach.

‘Whether it’s changes to diet and exercise, improving hydration or mindfulness, I encourage sustainable shifts.

‘Don’t go on a diet, instead understand why you should eat more fruit and vegetables and incorporate them in your life in a way that’s feasible.

‘If you start drinking more water, make sure you know the why of what water does for your body.

‘I find this approach encourages people to make changes that fit their lifestyle and that they feel motivated to keep up.’

Rule 2: Take steps every day to care for your skin

‘Remember that caring for your health as a whole prevents ageing and brings about beautiful skin,’ says Katy Burris, skincare physician.

‘Eat a diet filled with antioxidants, aim to drink at least eight to ten cups of water each day and be sure to exercise.

‘Take a vitamin D supplement to keep your bones strong and your immune system supported.

‘In addition, hydrate your skin with moisturiser twice daily and always wear sunscreen — it’s the best anti-ageing remedy we have.’

Rule 3: Don’t hesitate to take time off

‘Before starting my business, I worked remotely and found it challenging to switch off at the end of the day,’ says Emma Dechoux, a straight-talking leadership coach and inspirational mentor.

‘What helped was switching devices off and going for a walk or run.

‘This allowed me to decompress and reflect and return home re-energised.

‘It’s also important to be proactive with your self-care and I schedule at least one wellbeing day off per month.’

Rule 4: Get into a good sleep routine

‘Sleep plays an essential role in wellbeing and performance,’ says Matt Lovell, performance, nutrition and wellbeing specialist.

‘Ensure you follow the obvious rules: power down and try to be in restful mode a couple of hours before you want to sleep and steer clear of “blue light” devices like computers and phones.

‘Try some slow breathing, and if you have a pet, it can be quieting to spend time with them.

‘Being restful before sleep can help regulate your stress hormones, so when you do wake, you’re ready to go.’

Rule 5: Don’t be afraid to make a change

‘I work with many clients who feel unfulfilled in their work,’ says Lauren Phelps, change and accountability coach.

‘If you feel disengaged, uninspired and spend your spare time playing mindless games on your phone, it’s a sign you need a change.

‘Your past doesn’t dictate your future. Rise out of that rut.

‘There is a more compelling future waiting for you. Making tiny changes are small steps towards a better life.’

Rule 6: Get your ‘five-a-day’ for the mind

‘Each person is different in terms of how they support their mental health and wellbeing — meditation, mindfulness, exercise or therapy,’ says Charlie Hoare, positive psychologist and wellbeing consultant.

‘Try out some of these practices to determine what works for you.

‘Just as you’d aim to eat five fruit and vegetables per day to keep your body healthy, try to do five things to keep your mind healthy, whether that’s a moment of mindfulness or stepping into nature.

‘Try not to feel you need to be productive all the time; a rest is also good for the soul.’

Rule 7: Look up, around and forward

‘I have lived by this rule every day of my life since I retired from international rugby,’ says Catherine Spencer, former England rugby captain and female empowerment coach.

‘I use it to fuel my future in a positive way. It helps me to be focused, confident and ultimately happy.

‘It is important to have the confidence to try different things, to aim for goals and to aspire to our dreams; some we will achieve, some we won’t but that is OK.

‘It takes all of our experiences to push us forward.’

Rule 8: Prioritise your health

‘Make sure your health is always a top priority,’ says Peter Dale, Sky Sports presenter and inspirational broadcaster.

‘As someone who suffered a major heart attack aged 36 — even though I worked out and felt fit — I’ve learned it’s crucial to care for yourself and get your heart checked regularly.

‘If your body doesn’t feel quite right, don’t put off going to see the doctor.

‘Young people today have the pressure of high expectations and this can really impact their health.’

Rule 9: For happiness, find ways to serve others

‘During challenging times, turn off national and international news and tune into your community,’ says communications expert Jenifer Sarver.

‘Obsessing over global events which you have little control over can be overwhelming.

‘My solution is to prioritise what’s going on in my city, in my neighbourhood and take direct action to help.

‘I find serving others alleviates my own stress and anxiety.

‘Reaching out and helping others makes our lives richer and more meaningful and has a positive impact on our world.’

Rule 10: Make sure to listen to yourself

‘Take time and space to consider what’s working in your life and what isn’t,’ explains Dierdre Wolownick, language professor and inspirational motivator.

‘It’s important to make sure we’re living the life we want, not the life others think we should be.

‘Try journaling and reflecting on your entries. Or, get outside to experience nature and exercise; you don’t have to run a marathon.

‘Committing to physical activity can provide clarity on who you are and who you want to be.’

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People with intellectual and developmental disabilities disproportionately affected by COVID-19

The COVID-19 pandemic has taken a disproportionate toll on people with intellectual and developmental disabilities (IDDs), write the directors of the Intellectual and Developmental Disabilities Research Centers (IDDRC) Network, a nationwide group funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development. The article was written by John Constantino, M.D., director of the IDDRC at Washington University School of Medicine in St. Louis, along with fellow IDDRC directors and leaders of the Association of University Centers on Disabilities. It appears in the American Journal of Psychiatry.

A large number of people with IDD who require in-person care have lost the support of trained caregivers and community service providers due to the pandemic. The authors note that the Centers for Disease Control and Prevention and others have issued guidelines for group homes, schools, and others entrusted with the care of people with IDD. It is vital to ensure that when they return to work, care staff exercise techniques and procedures to protect their clients from infection, the authors write. Moreover, people with IDD depend on caregivers and loved ones to help them bridge gaps in intellectual and communication abilities. In the absence of this human contact, the authors call for virtual care and support, where viable. Those who cannot benefit from screen-based supports should be prioritized to receive in-person services.

Suspension of classroom time also disproportionately affects children with IDD, who often require special educational services, increased teacher-student ratios, and specialized interventions, many of which need to be administered in person, the authors note. It is difficult for families to take on these tasks, and qualified in-home surrogates should be mobilized whenever possible to meet this need and to support parents’ efforts.

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