The article is the third in the series of four that present the results of a study on environmental contaminants in coastal Chukotka, which was conducted in the context of a multi-disciplinary investigation of indigenous foodways in the region. The article presents the results of the analysis of metals found in the samples of locally harvested terrestrial, freshwater, and marine biota collected in 2016 in coastal Chukotka. For some species of local fauna and flora, the metals content was demonstrated for the first time. Lead and Hg were low in all foods, while As concentrations were up to four mg/kg ww in fish and marine mammals blubber. Wild plants showed accumulations of Mn (up to 190 mg/kg ww), Al (up to 75 mg/kg ww), Ni, Ba, and Sr. Seaweed contained high levels of As (14 mg/kg) and Sr (310 mg/kg); ascidians (sea squirts) contained Al (up to 560 mg/kg), Cr, and Sr; and blue mussels contained Cd (2.9 mg/kg) and Al (140 mg/kg). Exceedances over the Russian allowable levels were revealed for As, Cd, and Al in different food items. Absence of the established limits for Al and Sr in seafood, and Mn in wild plants and berries, impedes the determination of excess levels. Temporal trends and geographic comparisons of metals in foods have been carried out. The estimated daily intakes (EDIs) of metals by local food consumption were calculated based on the food intake frequencies. Follow-up (15 years after the first study) analyses of Hg, Pb, and Cd concentrations in local foods has not revealed any increase, while a slight decrease tendency was noted for some of the metals in several foods. Metals refer to persistent toxic substances (PTS), as they are stable and persistent in the environment, and do not undergo physical, chemical, and bacteriological degradation. The characteristics of some metals include global transportation  with atmospheric fluxes, river, sea, and oceanic currents; bioaccumulation and biomagnification in terrestrial and marine food chains; slow elimination from organisms, including humans; and variable toxicity, which can include adverse human health effects. Some metals cross the placental barrier, where they can affect the fetus during its development, and can be excreted in mother’s milk . Some meAlthough metals occur naturally in all of the ecosystems and have accumulated and cycled in the environment over geological time periods, significant quantities of metals are now introduced and redistributed in the environment by human activities such as fossil fuel combustion, different industrial processes , agricultural practices, transportation, and waste disposal at local, regional, and global scales. Anthropogenic activities now add metals to surficial environmental compartments at significantly greater rates than natural processes, with the possible exception of volcanic sources . At the Metals are redistributed within the Arctic via atmospheric, marine, freshwater, snow ice permafrost, sediment, and biotic transport mechanisms. The redistribution of metals leads to their presence at concentrations above the naturally occurring levels in locations that are remote from anthropogenic sources, and in forms that are available for biotic uptake. Metals pose a potential risk to the ecosystems and biocenoses of the Arctic . The dieMetals can accumulate in different organs and tissues of different animals, plants, and fungi. Most metals accumulate in the muscle and parenchymal tissues of fish, birds, and mammals, especially intensively in the liver and kidneys. In the fat of marine mammals, the content of some metals can exceed that of the muscles. The liver of bottom fish species  can accumulate significant levels of certain metals, especially when the water and bottom sediments of the reservoir are highly contaminated by these metals. Seaweed, benthic mollusks , and especially ascidians are able to accumulate extremely high concentrations of metals. The liver and kidneys of reindeer, which feed on lichen “saturated” with metals, also accumulate high levels of metals . Under cStudies on local food contamination by metals  that have been carried out over the last decades in the countries of circumpolar North have always focused on Hg and occasionally Cd (cadmium) and Pb. The summarized results of these multi-national studies are presented in the Reports of the Arctic Monitoring and Assessment Program (AMAP) ,5,6,7 anThe only metal that has been comprehensively investigated in different biota species at the circumpolar scale is Hg. A meta-analysis was applied in 83 time-series datasets of Hg in Arctic biota with the purpose of determining whether temporal trends exist in the data collected over the past decades 1975–2008). It was shown that nine significantly increasing time series were found for Canada (30% of the Canadian datasets), two significantly increasing time series were found for Greenland (13%), and one significantly increasing time series was found each for the Faroe Islands (14%) and Iceland (7%). Increasing Hg trends were found in marine invertebrates , seabirds , marine mammals  and freshwater fish . Only four (5%) of the time series showed a significantly decreasing Hg trend, and one of these also had a significant non-linear trend component. Two of these were for Atlantic cod from the Faroe Islands and Iceland, one was for Arctic char from Canada, and one was for reindeer from Sweden. None of the Arctic marine mammal or seabird datasets showed a significantly declining trend. The remaining 66 Hg time series showed either no trend or a significant non-linear trend component [5–2008. IThe collection and chemical analysis of local foods for Hg, Cd, and Pb were conducted in coastal Chukotka in 2001–2002 along with other Russian Arctic regions within the framework of the Russian Arctic PTS study ,11. The The objective of the present part of the project is to carry out an assessment of 18 environmental metals in subsistence species , compare the results of the three metals with those obtained in coastal Chukotka 15 years ago and during the recent follow-up and with other Arctic regions, and estimate the daily intakes (EDIs) of different metals with different food items by the local Indigenous people. The assessment of numerous metals in seafood  has been carried out for the first time in Chukotka coastal waters. Taking into account that residents of the Russian Arctic, including costal Chukotka Indigenous people, eat seafood (including ascidians), the analysis of metals in this group of local foods is of particular interest.Another important task is the evaluation of metal content  in the drinking water of each of the studied settlements, as the daily intake of metals is formed both by food and by drinking water. Drinking water in the Arctic sometimes is highly contaminated by metals when the settlement is near the ore mining and processing enterprises, e.g., by aluminum in Kirovsk city or by nickel in the Zapolyarny and Nikel cities of the Murmansk oblast .Collection of samples of local foods and drinking water were carried out in all three study settlements . Samples of fish , the meat of terrestrial mammals , the meat and blubber of marine mammals , mushrooms, berries, wild plants, seaweeds, ascidians, and mussels have been collected. Most of the samples have been kindly provided by the local people; several samples were collected by the Northwest Public Health Research Center (NWPHRC) specialists during fieldwork . Birds (except for one goose sample) and the viscera of marine and terrestrial mammals  were not available in the expedition season, and were absent in the storages of local people. Samples from multiple specimens of each biological species that were similar in age and size were pooled. Pooled samples accounted for 37% of the total sample number. When pooling the fish species, five to seven specimens were selected, the sizes of which were typical and average for these species; a piece of muscle tissue was cut from the central part of the specimen back , and packed together with several other pieces that were selected from different specimens of the same species, into one package. Hare meat was taken from the muscles of the lower limbs, while poultry meat was taken from the pectoral muscle, and marine mammal meat  was taken from the latissimus dorsi muscle. For the pooling of mushroom samples, seven to 10 caps were used. Wild berries and wild plants were pooled by weight: about 100–150 g. Marine weed and mollusk samples were pooled using five to seven specimens of similar size. After pre-treatment, packing, marking, and freezing, all of the samples were delivered to St. Petersburg in thermocontainers, which helped prevent thawing during transportation. All of the drinking water samples have been collected in each settlement, as well as in Provideniya and Anadyr (for the purpose of conducting the comparison); each 500-mL water sample was put into a plastic container with a screw top. The total number of samples that was collected and analyzed for metals is 79 ; among tEighteen metals , Cd, Hg, Cu (copper), Zn (zinc), Ni (nickel), Cr, Al , Mn, Ba (barium), Sr (strontium), Co , V (vanadium), Be (berillium), Mo (molybdenum), Sn, and Sb have been analyzed in all of the samples of local foods (fauna and flora) and in drinking water. Chemical analyses of metals in all of the samples were performed by the Northwest branch of Research and Production Association "Typhoon" (RPA “Typhoon”), St. Petersburg, Russia, which has international accreditation in the Arctic Monitoring and Assessment Program (AMAP) system. Inductively coupled plasma mass spectrometry (ICP-MS) was applied for the determination of metals, and atomic absorption spectrometry of “cold vapor” (AAS-CV) was applied for the determination of mercury. All of the samples were analyzed on a wet weight (w.w.) basis. Before analysis, solid food samples were thawed, dried, homogenized, and digested. An aliquot of a homogenized sample of approximately 1.5 g was weighed. Digestion was carried out by extra pure nitric acid, which was pre-distilled in a DistillAcid apparatus , in Teflon tubes in a MARS-5 microwave digester . Samples were exposed at 80 °C for 20 min, and then heated to 120 °C for 75 min with pressure control. The mineralized sample was diluted with high-purity water to a volume of 25 mL. Then, 100 mL of drinking water samples were treated by adding five mL of extra pure nitric acid. Analysis of metals in food and water samples was carried out by ICP-MS on a NexION-300D device . Instrument calibration was performed on multicomponent standard solutions ICP-MESS-4 and ICP-MESS-16 . An additive of yttrium (89Y), which was obtained by dissolving the metal oxide in extra pure nitric acid, was used as the internal standard. Analysis of metals was carried out in the kinetic energy discrimination, Dynamic Reaction Cell™, and normal modes.An analysis of mercury was carried out without digestion directly by AAS-CV (cold vapor method) on an RA-915M device with a Universal Mercury Prefix console . Limit of detection  for the analyzed metals in food and drinking water samples were at least 10 times lower than the corresponding established allowable levels. For quality assurance/control purposes, samples for international intercalibrations under the Canadian Northern Contaminants Program quality assurance/control were used. For the certified reference materials, all of the values were within ±20% of the reference values. International QA/QC intercalibration standards for metals were used under the aegis of the Canadian Northern Contaminants Program. The obtained results were within ±20% of the reference values.The analyzed concentrations of metals in local foods were evaluated in terms of comparisons between different species in coastal Chukotka and (as much as possible) in the corresponding species in other circumpolar regions, including the assessment of temporal trends of metals. The exceedances over the established limits were determined using Russian food safety regulation standards for metals in raw foods. Estimated daily intakes (EDIs) of metals by local food consumption were calculated based on the average concentrations of metals in local foods and on the intake frequencies of each food item, as reported by the respondents in the questionnaire. Using the hypothetically assumed one portion size as 150 g/meal of each foodstuff, the average annual EDIs of pollutants were calculated for each food group. Statistical treatment of the data was carried out using the Microsoft Office 2016 software package.Rhodiola arctica) accumulate Mn (up to 190 mg/kg ww), Al (up to 75 mg/kg ww), Ni, Ba, and Sr. Seafood (Laminaria saccharina) contains very high levels of As (14 mg/kg) and Sr (310 mg/kg); ascidians  are contaminated by Cr, Sr, and Al (up to 560 mg/kg); blue mussels accumulate significant levels of Cd (2.9 mg/kg) and Al (140 mg/kg).Concentrations of metals  vary hig Seafood  is a powIt is particularly important to assess the differences in As content in fish and marine mammal blubber , becauseDue to the limited number of the collected and analyzed samples, the present Chukotka study cannot provide a reliable or statistically significant comparison with the larger number of samples collected 15 years ago. However, comparison of the levels of Hg, Pb, and Cd was carried out with the data on the same species of fish, reindeer, and marine mammals collected in the neighboring Chukotsky coastal district in 2001–2002 . Table 3Codex Alimentarius [The current Russian hygienic regulation states the allowable levels of four metals  in raw foods , but coventarius  has feweentarius ,16, and entarius .The highest concentrations of metals in all of the analyzed samples of mammals, goose, fish, seafood, berries, wild plants, and mushrooms do not exceed the Russian allowable levels for Pb, Hg, Cu, Zn, and Ni. The exceedances for As, Cd, Cr, and Al are presented in The data of Samples of drinking water were collected in three studied settlements  and also in Provideniya and Anadyr (for comparison). All of the water samples have been analyzed for the same metals as in food. Concentrations of all of the studied metals were much lower than the established hygienic limits, and no exceedances over the Russian allowable levels of metals in water have been detected. The only exception was Cd in Enmelen drinking water (1.5 mcg/L), which is 1.5 times higher than the allowable level for Cd (1.0 mcg/L). The oral TDI of Cd is 60 mcg/person/day; a person drinking an average of two liters of water per day will ingest three mcg/day, which is a negligible addition to the amounts of cadmium entering the organism with Cd-rich seafood, but it is comparable to the consumption of about one kg of fish, land mammal meat, or mushrooms.Publications on metals in the fauna and flora in in the Bering Strait region are very limited. The few studies that have been carried out in the far eastern Russian Arctic and in northern Alaska focused on contamination of terrestrial and marine organisms by few metals . In the 2011 AMAP Mercury Report , which sSalmo salar) from Labrador displayed higher mean Hg values than their oceanic counterparts. Mercury concentrations in the muscle tissue of Arctic cod (Boreogadus saida) from the Lancaster Sound region were similar to those observed in Arctic char [Mercury in sea-run Arctic char was studied in the 1990s in 35 locations in northern Canada. In general, concentrations of mercury were <0.1 mcg/g ww in muscle at all of these locations. Mercury levels in sea-run char from eight communities in Labrador and the Ungava/Hudson Strait region of Nunavik were similar, with means ranging from 0.032–0.040 mcg/g ww. There were no significant differences in Hg levels among the three Labrador sites; however, one location in Nunavik (Quaqtaq) had higher levels than all of the other sites. Mercury levels were slightly lower in sea-run char from Southwest Greenland. Concentrations of Hg in land-locked char sampled in Kangiqsujuaq were about three times higher than in sea-run char. Landlocked populations of Arctic char and Atlantic salmon (A significant increasing trend of Hg have been noted in the period between 1995–2010 in the landlocked char and burbot from the Canadian NWT (up to 0.4 mcg/g ww in muscles). Nevertheless, a decreasing trend of Hg was determined for the same time period in Atlantic cod from Iceland and the Faroe islands .Arsenic was one of the most prominent metals in sea-run Arctic char samples from three communities in Labrador. There were no significant differences in the 1990s in concentrations of As between the three Labrador locations: 0.04–0.06 mcg/g ww. Arsenic levels were significantly higher in sea-run char at two of the four locations in Nunavik compared to the three sites in Labrador [Cadmium concentrations are not widely reported for freshwater fish, although existing data show concentrations in muscle to be around <0.005 mg/kg ww. Cadmium in muscle for various species of char from lakes in northern Labrador and Nunavik tended to approach very low detection limits (<0.001 to <0.006 mg/kg ww) [In the present Chukotka study, the concentrations of Hg in fish muscles were (in mg/kg ww): 0.01–0.02 ; 0.02–0.03 ; 0.04–0.05 ; 0.05–0.06 (searun char); and 0.1 (flounder). Concentrations of As were (in mg/kg ww): 0.15–0.2 (landlocked char); 0.25–0.4 (searun char); 0.3–0.45 ; 1.3 (flounder); 2.3–2.7 (pollack); and 3.0–4.0 , as shown in mantak  and walrus kopalkhen .Literature on metals in the Arctic marine mammals is rare, and mainly refers to polar bears and belugas, and in a few cases to ringed seals. The analyzed tissues usually include liver and kidneys. The present study is lacking viscera samples of marine mammals, as they were not available during our fieldwork in Chukotka. The marine mammal tissues that have been sampled and analyzed in the present study are meat and blubber, including whale mantak were relatively similar to the levels in blubber  are a particularly common biomonitor in national programs, where ongoing monitoring is conducted at selected locations. Blue mussel (Mytilus edulis) data are now available for several Arctic locations, including the Arctic components of national monitoring programs. Mussels  and mercury (0.03 mcg/g ww) were found in blue mussels from six communities in the Hudson Bay, Hudson Strait, and Ungava Bay areas. There were no major differences in the levels of metals between mussels collected in Nain and Makkovik and those from Nunavik .Mercury concentrations in blue mussels sampled between 1995–2000 were generally <0.03 mg/kg ww, and no circumpolar trend was apparent. The mean Cd concentrations in blue mussels from different Arctic countries collected between 1995–2000  were in the range 0.2–1.0 mg/kg ww. Mussel concentrations in Qeqertarsuaq, Greenland were high compared to other Arctic locations (1.1 to 2.3 mg/kg ww), which was probably due to the local geological conditions. [In the present Chukotka study, Hg levels in all of the sampled invertebrates (including blue mussels) were <0.005 mg/kg ww, while the Cd level in blue mussels was 2.9 mg/kg ww .A Greenlandic monitoring study of metals in blue mussels at the Seqi olivine mine  .A Greenlandic monitoring study of the metals in brown seaweed ine mine   [The study of metals in valbard)  has demoThe exceptional water filtration capacity of adult tunicates can sometimes result in the accumulation of pollutants at levels that may be toxic to the tunicate itself, or may make their tissues toxic to predators, including humans. Ascidians may contain metals, including manganese, magnesium, iron, molybdenum, niobium, tantalum, chromium, titanium, and vanadium . Some as7 times higher than that in seawater. The vanadium-binding protein, Vanabin, which is isolated from ascidian, is thought to act as a metal chaperone in ascidian blood cells. Vanabin can be used as an agent for the selective bioaccumulation and biosorption of heavy metals [Halocynthia aurantium.Rare metals such as vanadium and cobalt are dissolved in seawater at very low concentrations. Ascidians are known to accumulate extremely high levels of vanadium selectively. Vanadium is accumulated mainly in their blood cells at concentrations corresponding to 10y metals . In the Species of ascidians differ in their capacity to accumulate different metals. This may be due to the variations in the availability of metals and their role in the metabolism of a given species. Many researchers have reported variations of metal accumulation in ascidians. A study in the Thoothukudi coast of India showed that among the four metals studied in seawater, Cu accumulated in the highest concentration, followed by Pb, V, and Cd . We did not find any literature on the contamination of ascidians by metals in the Arctic, including the areas of the Chukchi, Bering, and Beaufort seas. Therefore, the present study  in the cTo our knowledge, this is the only study examining multiple metals in the variety of local subsistence foods from the coastal Chukotka since the beginning of the 2000s. For some species of local fauna and flora, the content of metals was demonstrated for the first time.Rhodiola arctica) accumulated Mn (up to 190 mg/kg ww), Al (up to 75 mg/kg ww), Ni, Ba, and Sr. Seafood species were highly contaminated by several metals ; seaweed (Laminaria saccharina) contained very high levels of As (14 mg/kg) and Sr (310 mg/kg); ascidians  were contaminated by Cr, Sr, and Al (up to 560 mg/kg); blue mussels accumulated significant levels of Cd (2.9 mg/kg) and Al (140 mg/kg). Levels of metals were very different in various foods. Lead and Hg were low in all of the foods; As levels were up to four mg/kg ww in fish and the blubber of marine mammals. Wild plants  of metals is formed by multiple food items: Pb, mainly by meat of land mammals and fowl; As by seafood and fish; Hg by fish and sea mammal meat; Cd, Al, Sr, and Ba by seafood; and Ni and Mn by wild plants.Follow-up analysis of Hg, Pb, and Cd in local foods (conducted 15 years after the first study) has not revealed any increase trend; the slight decrease tendency was noted in arctic char , flounder (Pb and Cd), ringed and spotted seals (Hg), and bearded seal (Hg and Pb).Geographic comparisons based on the available literature (which is scarce for the Bering Strait region) for Hg, As, Cd, and Pb in the main food items, which are monitored at the circumpolar scale, has not revealed new insight.


Attentional bias has been defined as the propensity of a person to allocate selective attention automatically to salient cues (Field and Powell,  Growing evidence of the negative effects of tobacco cigarette smoking on health has had little impact on the real extent of this phenomenon and in promoting solutions  undergo a change in their cognitive status: from the original neutral status, they become conditioned motivational triggers Marlatt, . This prThe AB intensity depends on a variety of factors, some linked to personal characteristics and other to contextual factors. For example, Di Chiara  affirmedThe AB has an important effect on action. It seems to facilitate the repetition of smoking Tiffany,  and the A few studies investigated the presence of AB in former smokers, some reporting a similar attention reactivity to smoking cues in current and former smokers, and some other disconfirming this view. In particular, Ehrman et al.  found thAccording to this background, the primary aim of the current study is to investigate the presence of the AB in former smokers and to compare this effect on a sample of current smokers. In particular, we were interested in former and current smokers with a long history of cigarette smoking and, in the case of former smokers, with consolidated abstinence (being abstinence for at least 1 year). Although our main aim is to compare smokers and former smokers, we also collected data on a sample of people who have never smoked, so to have a benchmark for the variables we used.We defined AB as a significant increase in response time to SC during the Emotional Smoke Stroop task with respect to the response time to color coherent (baseline) condition. Therefore, we hypothesized that the effect of the AB, i.e., the smoking-related latency, is higher in smokers than former smokers, while non-smokers should not be affected by SC, showing latencies similar to the coherent condition.We also expected to find differences with regard to implicit processes. In fact, the AB may be considered a measure of cognitive implicit processes  aged 51.79  were recruited. The sample of the present study consisted of 98 current smokers (40%), 102 former smokers (41.7%) and 45 non-smokers (18.3%).Smokers and former smokers were recruited within the participants at the Continuous Observation of SMOking Subjects I (COSMOS I), a screening program for early detection of lung cancer using a low-dose computed tomography (CT) scan, run at the European Institute of Oncology (IEO) in Milan, Italy. Detailed information about COSMOS I protocol has been published elsewhere  approved the study. All enrolled participants read, filled in and signed the informed consent form. The study was in accordance with the principles stated in the Declaration of Helsinki .Data collection consisted in two consecutive phases. In the first one, in order to obtain a psycho-cognitive profile, each participant received a set of article and pencil questionnaires to be carefully read and filled out in a quiet room. Overall, the mean time required to complete questionnaires was about 20 min per participant. Then, in the second phase, a computerized short neuropsychological battery was delivered by the use of the Millisecond Inquisit Lab software (version 4.0). Participants had the time to familiarize with the software for 5 min. A further familiarization period was also provided before every single test within the battery. At the end of the assessment, each participant took part in a debriefing section, during which smoking cessation strategies were also discussed (about 15 min).A 20-item self-administered questionnaire assessing the affective reaction to punishment and reward. Answers were assessed using a five-point Likert scale . The questionnaire includes six subscales: Behavioral inhibition system (BIS); Behavioral activation system (BAS); Drive; Fun seeking; Reward responsiveness ; middle (3–4); strong (5–6); very strong . It is made by three subscales: attentional impulsiveness, motor impulsiveness, and non-planning impulsiveness. Higher values indicate higher impulsivity . Higher values are suggestive of higher motivation Marino, .This task measures inhibition and response control  and speed of response execution (reaction times to go targets).This task was adapted from the original version of the Stroop Task Stroop,  in orderDescriptive statistics were used to describe the sample’s characteristics. The AB was calculated using the latency time between the presentation of the stimulus and the verbalization of the ink color for SC, NC, congruent color words (CC), and incongruent color words (IC). Inhibition was instead assessed using reaction times and the number of errors in the Go/No Go task.More specifically, in order to avoid biases due to the different sample sizes, we ran a one-way analysis of variance (ANOVA) using smoking status  as a fixed factor and latencies at smoking-related words as a dependent variable. Since we defined AB as the difference between the response latency to a SC and the latency at the congruent stimuli (CC), we computed a new variable (AB) subtracting the mean latency at CC from SC. Therefore, a second one-way ANOVA test was run on this variable. When the interaction between variables was considered of interest, mixed design ANOVAs were used to compare the latencies at different tasks between groups . Bonferroni corrections for multiple paired comparisons were applied.p values was used also for correlations. Finally, two linear regressions were performed for current smokers and former smokers. In the first linear regression for current smokers, AB index was used as the criterion variable, while impulsiveness, years of smoking, number of daily cigarettes, dependence level, BIS/BAS subscales and age as predictors. In the second linear regression for former smokers, AB index was included as criterion variable and impulsiveness, number of years as smokers, number of years from the interruption, BIS/BAS subscales, and age as predictors. All the analyses were performed using the SPSS package .The Pearson coefficient was used in order to assess the association between impulsiveness, BAS and BIS, nicotine dependence, the number of cigarettes per day, and the age of the first cigarette. Bonferroni correction for the Smoking characteristics of current and former smokers are reported in F = 3.101, p = 0.0041), with no further differences in BIS, BAS, and BIS-11 dimensions.An ANOVA test was run to compare BIS/BAS and BIS-11 among groups. Current smokers resulted lower in reward responsiveness  calculated as the number of errors on No-Go trials divided by the total number of No-Go trials.F = 0.722, p = 0.495). The mean latency was 677.12 ms for current smokers, 683.27 ms for former smokers and 685.84 ms for non-smokers  = 0.525, p = 0.594).No differences between the three groups were found. In particular, the false alarm rate was 0.443 for current smokers, 0.395 for former smokers and 0.492 for non-smokers  = 3.822, p < 0.029). Bonferroni pairwise comparisons showed current smokers and former smokers to be significantly slower than non-smokers . The other ANOVAs did not report any significant effects.We first ran one-way ANOVAs on latencies (dependent variable) at each Stroop condition  to test differences between current smokers, former smokers, and non-smokers (fixed factor). We found a significant difference between groups only for the smoking cues  = 8.561, p < 0.000). In particular, Bonferroni post hoc analysis revealed that non-smokers were significantly faster than former-smokers (p < 0.002) and current smokers (p < 0.001).A further one-way ANOVA was run using the attentional bias index (AB) as dependent variable and smoking status as fixed factor . The difference between the smoking status groups was significant  = 93.053, p < 0.000), while the interaction stimulus × smoking status was not significant  = 0.844, p = 0.470).Finally, a mixed-design ANOVA was run using stimulus  as within factor and smoking status (current smokers and former smokers) as between factor. As expected, we found a significant difference for the main effect stimulus (p = 0.011), smoking-related words (p = 0.019), and neutral words (p = 0.025). Finally, no-planning impulsiveness correlates with NC (p = 0.029), while there is a negative correlation between NC and reward responsiveness in the BIS/BAS (p = 0.038). No statistical correlations were observed for former smokers and non-smokers  and a negative correlation between total impulsiveness and response latency (p = 0.016). In addition, former smokers showed a positive correlation between the BAS and the number of false alarms (p < 0.001), and a negative correlation between total impulsiveness and response latency (p = 0.012). Other correlations were reported for singular subscales of BIS-11 and BIS-BAS in Current smokers showed a positive correlation between total impulsiveness and number of false alarms  as dummy variable and years of smoking, number of daily cigarettes, in the first block, and then we added impulsivity in the second block and BIS/BAS subscale in the third. We found that the smoking-related AB was not predicted by any of the variables considered.According to the Incentive Salience theory of addiction and PC theory, stimuli associated with tobacco cigarette smoking acquire high approach value  reported similar performance at the standard Stroop task and at the Go/no-Go task. Consequently, we may assume that the AB found in current and former smokers was not due to the impairment of general cognitive control functions, such as inhibition mechanisms. Previous studies on alcohol and cocaine abusers showed that there is an impairment effect of drugs on inhibition and that this effect is detectable at doses that do not lead to a global impairment in cognitive performance at a Go/no-Go tasks . Consequently, we believe that research on tobacco smoking needs a wide-range approach.The last concern is linked to the fact that having only behavioral data, we cannot support our finding from a neuro-functional point of view. Consequently, some of the issues raised are speculative. However, behavioral and neuroscientific data need to be integrated within a common and sound neuro-cognitive model, so to provide effective data both to researchers and health professionals. For these reasons, we believe that the research about AB should follow parallel pathways, without discarding data sources that proved to be useful, even though they are by their nature imperfect.In conclusion, our results suggest and support future research, also integrating and advancing previous evidence that reported partial and contrasting data on small samples and on recent or even very recent former smokers.The Ethical Committee of the European Institute of Oncology approved the study. All enrolled participants were provided with full details about the study. All participants complied and signed the informed consent form. The study was in accordance with the principles stated in the Declaration of Helsinki .GP, CL, MM, PM, and GV conceived and designed the study. GP coordinated the study. CL and GP acquired legal authorizations. MM managed the participants. Statistical analysis was performed by CL. Drafting and writing of the manuscript were handled by CL, MM, KM, and GP. All authors have read and approved the final manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Science has to take responsibility! Our common future is already determined by research and by new technologies emerging from new knowledge, and this process continues to gain speed. We have to make sure that today's amazing developments are used to benefit all of humankind. This is what people expect from the progress. Health and wellbeing is what people are most concerned about. Health may be a human right but when it comes to health, the world is in a worrisome state despite all the great progress, which we have seen in the past years. Infectious diseases and pandemic preparedness remain on the world agenda but the chief causes of death are now shifting dramatically to non-communicable diseases. The burden of disease of e.g., obesity, diabetes, cardiovascular diseases, cancer, and mental health are increasing in all countries around the globe—rich and poor. In addition food and nutrition, pollution, climate change, political instability in many regions, economic crisis, migration, and flight are all contributing factors in major health issues. Meanwhile, the world's population continues to grow and to age. The global burden of disease remains, and is even on the rise in some areas. Equity remains a challenge. This may not be completely new but it is urgent for us to act. Climate is just one example that action is needed—now! We are not making good use of our scientific and technological possibilities and we are not living up to the expectations of the generations of our children and grandchildren.Ever since the first World Health Summit on the occasion of the 300th anniversary of the Charité–Universitätsmedizin Berlin, we have been working toward one goal: improving health for everyone on the planet. We have to respond to the most important global health challenges, and must find fast and efficient ways to bring medical advances to the places where people are in need. But each of us can do very little alone. That's why from the beginning, the World Health Summit has brought together stakeholders and decision-makers from every sector, from all over the world. By combining forces from academia, the private sector, industry, civil society, and politics, we have been able to achieve change and improve health worldwide. And there are now some very promising leads on how we can do even more.The “M8 Alliance” of 25 Academic Health Centers and Universities around the globe and the 130 Academies of Medicine and Sciences in the InterAcademy Partnership (IAP) provide a unique think tank for the World Health Summit program in academic freedom. We try to help setting the global health agenda including the G7/G20 Summits and stimulating the building up of global health structures, careers and programs in institutions and nations—and inviting politics, industry, and civil society to cooperate in a transparent way.A milestone—and an encouraging sign—is the prominent position that health topics have assumed on the agendas of the G7 and G20 meetings. From the very beginning, the World Health Summit has enjoyed support from the highest level of politics, with ongoing high patronage from the Chancellor of Germany, the President of the French Republic and the President of the European Commission.The Sustainable Development Goals (SDGs) and Agenda 2030 provide the framework for a holistic health approach in every area of policymaking. We do believe that such a holistic approach to health, is frequently discussed but is still largely neglected by too many people with responsibility and by too many institutions and urgently needs strengthening. In fact, the fragmentation of approaches, disciplines, particular interest groups and ideologies is obvious in science as well as in politics, private sector, and civil society. The challenge of the future is to cope with complexity. Global Health is one of the most complex issues—it would be a great example to develop a comprehensive holistic and successful model fitting for the great variety of good intentions and fragmented efforts.It is encouraging to see important NGOs, private foundations and other key organizations playing an increasingly supportive and coordinated role in achieving the Sustainable Development Goals in tandem with the United Nations and the World Health Organization. We need efforts that are transdisciplinary, science-based, cross-sectoral, and concerted. They are vital to set the global health agenda for the years to come. Participants from all over the world bring different views, experiences, and priorities. They aren't only welcome—they're the very essence of the World Health Summit vision, mission and philosophy.The World Health Summit (WHS) was established in 2009 as an international, interdisciplinary conference in Berlin. From the start the goal was to find faster, more efficient and more equitable ways to advance health on a global scale. This could not be achieved through bringing together research and academia alone, many other stakeholders were required: politics, civil society, and the private sector. The WHS highlights the joint efforts in working toward one goal—improving health for everyone on the planet.whole picture as its guide.From the very beginning it was clear to us that science has to take more responsibility and that it was important to create a novel forum which had the From the very beginning, the WHS has enjoyed support from the highest levels of European government, with the consistent high patronage of the Chancellor of Germany, the President of the French Republic and the President of the European Commission. Several heads of state, leaders of international organizations and NGOs, CEOs of industry and leading members from academia have confirmed their participation in the 10th anniversary summit in 2018—10 years on, the World Health Summit has become the foremost international multisector strategic forum for global health. It has also generated regional conferences and expert meetings on specific topics around the globe.From the beginning it was the hallmark of the WHS to include the best of science and all aspects of its translation into global health. The goal, however, was to go beyond medicine and to develop a truly holistic view of health encompassing all complex aspects of biology, medicine and the specific conditions we live in, our environment in the different parts of the world and importantly our behavior, lifestyles, social, and economic determinants as well as the various cultures around the world. This interface is clearly reflected at the 10th anniversary in 2018 in Berlin: on this occasion the World Health Summit is organized jointly and back to back with the “Grand Challenges Partners” including Grand Challenges Canada, the German Ministry of Education and Research, USAID, the Wellcome Trust and the Bill and Melinda Gates Foundation.M8 Alliance of Academic Health Centers, Universities and National Academies of Medicine and Sciences—the Summit's academic think-tank from its very early days. This M8 Alliance importantly includes the InterAcademy Partnership IAP of all 130 National Academies of Medicine and Science around the world. The World Health Summit contributed to political agenda setting and the prominent position which health topics have assumed on the agendas of the G7 and G20 Summits since the Heiligendamm G8 Summit in 2007, strongly and independently also supported by the National Academies of Sciences and based on the increased commitment of several countries including Germany to global health. Issues that have been addressed at the WHS by leading international experts contribute to set the political health agenda and vice versa progress continues to be discussed on the programs of the WHS. New topics of global health are continuously added to the plenary sessions or smaller workshops of the WHS. With 2 major meetings per year and the expert meetings around the world now provide a reliable international platform for acute burning and long-term global health issues open to all stakeholders. Programs such as The Young Physicians Leaders (YPL) and the New Voices program have helped a young enthusiastic international global health community to flourish. The WHS continues to be a major stimulus to foster national and international science and education programs and sustainable structures for teaching and research of global health at universities. The last 10 years have shown a remarkable development of global health research, international programs and teaching in many institutions beyond the members of the M8 Alliance.The WHS can look back on several major scientific and political milestones: in international scientific cooperation the start was the founding of the The Sustainable Development Goals (SDGs) of the United Nations and the Agenda 2030 with the World Health Organization (WHO) as the main player in global health, have provided the framework for and are based on a holistic approach to health in science and policy. The World Health Summit and the M8 Alliance share this holistic view and concept with the UN and WHO. This facilitates the participation of so many important organizations to play increasingly supportive roles in achieving those goals. This joint commitment and collaboration is necessary if we want to live up to the expectations and hopes of so many people around the world. With this great and productive diversity of actors, stakeholders, institutions and expertise in global health, it will be increasingly important and urgent to agree on such an inclusive and holistic view of health and on a common basis of facts, concepts and approaches. The “health in all policies” project of the InterAcademy Partnership (IAP) is an important part of this strategy.The multidisciplinary and multisectoral approach in the political arena and of the WHS importantly is also driven by strong and new scientific arguments. Complex environmental factors, climate, pollution, preservation of nature, biodiversity and animal health have clearly been shown to be closely linked to and to have major effects on human health. This is the basis for the important concept of “One Health” and “Planetary Health.” Since the dawn of civilization there was no major distinction between diseases affecting humans and animals, and the interplay between their respective ecosystems was well accepted. Hippocrates' treatise “On Airs, Waters, and Places” explicitly recognized that the environment is inherently interlinked with health. Such thinking was revived in the nineteenth century by Rudolf Virchow, who proclaimed that “…between animal and human medicine there are no dividing lines–nor should there be,” which then heralded the necessity of the control of zoonoses such as the highly pathogenic avian influenza, Ebola, and rabies as well as the increasing challenge of antimicrobial resistance (AMR). Now we have precise knowledge of the exact transmission pathways from animals to man and back to animals. We have increasing insight into the vectors and hosts and we learn to control, treat and prevent infections.This mandates interdisciplinary research closely linked to multi-sectoral policies and regulatory guidelines concerning poultry and livestock production, as well as marketing practices, food safety policies, and guidelines, legislation of the use of antibiotics in animals and their enforcement. At the international level, this has led to increasing collaboration between basic sciences and political agencies such as the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the Organization for Animal Health (OIE).Basic research remains an increasingly important part in our efforts to work for a better future. Understanding complexity will remain the basis for unifying theories and holistic concepts. The Darwinian revolutionary hypothesis on the origin of species is such a strong unifying hypothesis. This has now become in resent years a new and very precise science that has been termed “Evolutionary Medicine” and “Evolutionary Global Health.” Such a development has become possible by the development of revolutionary new methods including genomics and genetics and the molecular analysis of the evolution of plants, animals, and man. These new insights have helped to develop a new theory of life. It provides new insights as to why human biology is the way it is, why people are frail and why they get sick and how to preseve better health rather than simply focus on treating diseases. A better understanding of the evolution of life on earth including health and diseases at the genomic and molecular level also provides a scientific rational for a holistic approach to health and disease integrating the complex interactions between our biology, the environment and our behavior. The gap e.g., between our evolutionary “old” biology and our modern, fast-changing, frequently man-made new environments such as cities and nutrition, helps to explain many diseases of civilization.The SDGs respond to these complex interactions and provide a framework for a holistic answer to the ensueing challenges. Implementation of the SDGs started worldwide in 2016 in a process also referred to as “Localizing the SDGs.” All over the planet, individual people, universities, governments, institutions, and organizations of all kinds select “their goals” according to their expertise, capacities, means and knowledge. In each country, governments must translate the goals into their national legislation, develop a plan of action, establish budgets and openly and actively search for partners. The big challenge is to maintain the holistic view while encouraging diversity.whole picture as its guide. “Good health and wellbeing” may be specifically mentioned just in SDG 3 but it is included in all 17 SDGs: from SDG 1 “no poverty,” SDG 2 “no hunger” to SDG 16 “peace, justice and strong institutions” to SDG 17 “partnerships for the goals.” Health is an extremely good entry point to the complexity of the SDGs because it is easily understandable as an important concern for life and death for the individual person and for society at large.The World Health Summit's hallmark is this interdisciplinarity and the multistakeholder participation and interaction—this is one of the reasons the leaders of Ghana, Norway, and Germany have invited the WHO Director General to present at the WHS 2018 an action plan for the implementation of the SDGs including all relevant organizations and coordinated under the leadership of WHO. It reflects the importance of a forum which has the Improving global health requires input from many disciplines beyond and above medicine, biology, agriculture, nutrition, oceanography, and including the social and environmental sciences, humanities and engineering, allied health professions, all of which are essential for the implementation of health policies and programmes. This need for interdisciplinary action extends to “Health in All Policies,” an approach to public policies across sectors e.g. research, education, health, digitalization, economy, energy, foreign policy, security, and finances that systematically take into account the health implications of decisions of each of the government ministries and sectors to seek synergies and avoid harmful health impact to population and global health. Such initiatives have been asked for since the Alma-Ata Declaration in the 1970s but the results are far from being satisfactory in most countries. Climate is just one powerful example of how global trends  affect health and require a “Health in All Policies” approach to be addressed effectively and avoid counteractive actions.Diversity of participants from all parts of the world, different cultures, professions, interest groups makes the meeting productive. The workshop “Respect and Dialogue” hosted by the M8 Alliance and InterAcademy Partnership IAP is an attempt to provide an intellectual basis for the SDGs and an example for exercise in constructive discussions in academic freedom. The “Health in all Policies” session is based on the view that health is a human right and a political choice. Other major topics of the World Health Summit 2018 such as “Pandemic Preparedness,” “Migration and Refugee Health,” “Health System Strengthening,” “Antimicrobial Resistance,” “The Digital Healthcare Revolution” all need to be integrated into the bigger holistic picture of global health. The issue of gender equity is addressed throughout the WHS.The World Health Summit has become a unique forum to garner high-level political, civil society, academic and industry engagement in global health. It is further strengthened by the significant increase of support to global health by the German government and the relevance of Berlin as a global health hub. As stakeholders from areas other than health contribute to the World Health Summit, health actors need to ensure their participation at other fora such as the Munich Security Conference, or the Global Solutions Summit. By participating in these activities, steps will be made to ensure global health is represented in all political dialogues and ultimately in all policies.Such transdisciplinary, science based, cross-sectoral concerted efforts are necessary to set the agenda for global health for the years to come. Participants from all over the world with their different views, experiences and priorities and interests are thus not only welcome—you are the essence of the World Health Summits vision, mission, and philosophy.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.Lancet (2003) 362:903–8. doi: 10.1016/s0140-6736(03)14335-8Beaglehole R, Yach D. Globalisation and the prevention and control of non-communicable disease: the neglected chronic diseases of adults. The Global Economic Burden of Non-communicable Diseases. Geneva: World Economic Forum (2011). Available online at: http://apps.who.int/medicinedocs/documents/s18806en/s18806en.pdf .Bloom DE, Cafiero ET, Jané-Llopis E, Abrahams-Gessel S, Bloom LR, Fathima S, et al. Bull World Health Organ. (2002) 80:952–8.Chopra M, Galbraith S, Darnton-Hill I. A global response to a global problem: the epidemic of overnutrition. 2017 Global Life Sciences Outlook (2016). 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Lancet Planetary Health (2017) 1:e4–5. doi: 10.1016/s2542-5196(17)30003-7Haines A. Health co-benefits of climate action. Health Promot Int. (2014) 29 (Suppl. 1):I19–28. doi: 10.1093/heapro/dau035Health in all policies (HiAP) framework for country action. Ipsos Public Affairs: What Worries the World. Available online at: https://www.ipsos.com/sites/default/files/2017-08/What_worries_the_world-July-2017.pdf .Health Pol Plan. (2011) 27:288–300. doi: 10.1093/heapol/czr038Jacobs B, Ir P, Bigdeli M, Annear PL, Damme WV. Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries. M8 Alliance Declaration. World Health Summit 2017. Health is a Political Choice (2017). Available online at: https://d1wjxwc5zmlmv4.cloudfront.net/fileadmin/user_upload/downloads/2017/WHS_Berlin/Data/M8_Alliance_Declaration_2017_Berlin.pdf .M8 Alliance. Eur J Neurosci. 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Background: Generalized anxiety and oppositional defiant disorders are among the most common psychopathological disorders in pre-school children. We investigated the symptom rate and perception of the child's disorders in parents of preschool children with generalized anxiety disorder (GAD) or oppositional defiant disorder (ODD).Methods: The parents of preschool children  with ODD, GAD, or typical development (TD) filled the Symptom Check List-90-Revised (SCL-90-R) and the Child Behavior Checklist- 1½−5 (CBCL 1½ 5). Parents and children's diagnoses were determined by clinical assessment.Results: The parents of children with ODD reported a symptoms rate higher than parents of children with GAD or TD on most of the SCL-90-R .Conclusions: On the CBCL scales, the parents of the ODD group overestimated the children's problems, while parents of children with GAD reported mainly children's emotional difficulties. Parents of children with ODD seem to be psychologically more vulnerable than parents of children with GAD. Parenting programs might be tailored considering the child's diagnosis and family functioning. Oppositional defiant disorder (ODD) and generalized anxiety disorder (GAD) are among the most common psychiatric disorders in pre-school-aged children. The key feature of GAD is excessive and intrusive worrying that disrupts daily functioning and is associated with symptoms of restlessness, fatigue, difficulty concentrating, irritability, muscle aches or tension, or sleep difficulties. Children with ODD presented a persistent pattern of behavioral problems, including anger, irritability, arguing, defiance, or vindictiveness toward parents and other authority figures –4.Early childhood anxiety disorders are predictive of anxiety and mood disorders in later childhood. Luby et al. showed that pre-school depression is not a transient or non-specific developmental phenomenon but an early expression of the same chronic and relapsing disorder during late childhood and adolescence , 5, 6. OWithin a project aimed at identifying the protective and risk factors for psychopathological trajectories, the present study investigated the parental symptom rate and parental perception of the child's psychiatric disorders in parents of children with ODD, GAD, or typical development (TD).Family history of psychopathology  in pre-schooler children increases the risk for the development of psychiatric disorders in offspring –23. In pTo measure parents' perception of their own personal mental health conditions, all parents were asked to complete the Symptom Check List-90-Revised (SCL-90-R) –31. We eWe hypothesized that parents of children with GAD would be less aware of the psychopathology of their children than parents of children with ODD. Unlike children with ODD, children with GAD show behaviors that are often underscored by the parents . We expeIn summary, despite the steady and increasing interests toward psychopathological conditions in childhood, relatively few studies focused on the family environment in pre-school children with GAD and ODD –37. The The sample consisted of 124 Italian preschool children  and their parents. The children were recruited over the last 5 years (2013–2018).n = 41) or ODD (n = 41) diagnosis.The psychiatric disorders were assessed according to DSM-5 criteria and confirmed by the Kiddie Schedule for Affective Disorders and Schizophrenia interview (K-SADS-PL) as well as by a complete clinical assessment –40. PresThe comorbidity with any additional psychiatric disorders  and/or QI < 80 were considered as exclusion criteria. All children were free of medication at study entry.A total of 42 children with typical development were recruited through advertisements among nursery school. These children were not impaired on relational and psychological levels.Patients and children with TD had a comparable gender ratio, age, and group level according to their socio-demographic background see .All the children and their parents were evaluated by trained clinical psychologists and child psychiatrists.Clinical assessment of all children and their parents was performed according to a three-step process.The first step consisted of an anamnesis , clinical interview with the parents together, and psychiatric assessment of the child.In a second step, the children performed a comprehensive neuropsychiatric evaluation , during which the disorder was confirmed. Both parents were also asked to assess the behavioral and emotional problems of their children by filling out a symptom checklist together . The questionnaire regarding the parents' psychological profiles  was filled out by the mother and father separately.In the third step, the clinicians discussed the parents' psychopathological risk and the child's diagnosis with the parents.The study was carried out in accordance with the Declaration of Helsinki and approved by the institutional review board of “Sapienza” at the University of Rome.All parents gave a written informed consent to participate in this study.The anamnesis of children was carried out by a child psychiatrist asking specific questions .The psychiatric diagnosis of the children was made according to DSM-5 criteria and confirmed by the K-SADS-PL interview.The parents' psychiatric diagnosis was made by a psychiatrist from the adult mental health service.The Italian version of the SCL-90-R was used to measure the psychiatric distress of family caregivers for children with ODD, GAD, and TD .The SCL 90-R consists of 90 multidimensional items. Each of the 90 items was rated on a five-point Likert scale (from 0 = “no problem” to 4 = “very serious”). Subsequently, the answers were combined in nine primary symptom dimensions: somatization (SOM), obsessive-compulsive (O-C), interpersonal sensitivity (I-S), depression (DEP), anxiety (ANX), anger-hostility (HOS), phobic anxiety (PHOB), paranoid ideation (PAR), and psychoticism (PSY).In addition, three global indices provided measures of psychological distress: the Global Severity Index (GSI), the Positive Symptom Total (PST), and the Positive Symptom Distress Index (PSDI). The SCL-90-R comprised seven additional items (Other) to measure possible disorders in appetite and sleep. Following Derogatis , we usedThe CBCL 1½−5 is a parent questionnaire assessing emotional and behavior problems in children. Parents rated their children on 100 items using a 3-point scale: 0 = “not true,” 1 = “somewhat or sometimes true,” or 2 = “very true or often true.” A Total Problem score, two broadband scores , and six different syndrome scales were deployed.Six syndrome subscales contributed to either the broadband Internalizing or Externalizing domains. Only one syndrome scale, Sleep Problems, did not contribute to either broadband but did contribute to the Total Problems Score.Syndrome scales: borderline clinical range spanning from T Score 65–69 (93rd to the 97th percentile of the normative sample of non-referred children). Scores above the 97th percentile were considered to be within clinical range.Internalizing, externalizing, and total scales: borderline range spanning from T score 60–63 (83rd−90th percentile).Also, the borderline DSM-oriented Scale ranges from T score 65–69 (93rd−97th percentile of the normative sample of non-referred children).The analysis of demographic variables was performed by the analysis of variance (ANOVA) for continuous measures  and the Pearson's χ2 for categorical measures .post-hoc analysis with an adjustment for “child's age” as covariate. Parents (mother vs. father) were considered as a within-subject factors. Linear and logistic regressions were performed to determine the association between parent and offspring psychopathology. To measure the magnitude of the risk for psychopathology in children, an odds ratio was calculated for children with and without psychopathological parents.For the SCL-90-R and CBCL 1½−5, differences between groups were analyzed by means of analysis of variance followed by Statistical analyses were performed using SPSS version 23.0 .We found no significant differences across groups regarding the parents' age  and education level. Overall, the majority of families (73%) had a middle education level, and the remaining families had either low (9%) or high (18%) education levels .In most of the cases (75%), the children were referred for diagnosis by the parents. Only in 9% of cases were children referred by teachers, and in 16% of cases they were referred by pediatricians, and there were no differences between groups.With respect to the sex and age of the children, there were not significant differences between groups. Across the groups, the majority of children were males (64%).Overall, 14 mothers and 15 fathers had symptoms of anxiety and/or depression.p = 0.003). As expected, parental psychopathology was associated with a strong likelihood of GAD  and ODD in children . However, the presence of a parental psychiatric diagnosis was not associated with the type of referral  of children.We found that children with a psychiatric diagnosis were more likely to have at least one parent with psychopathology than TD children  = 4.5, p = 0.010; F = 5, p = 0.010; F = 4.3, p < 0.010; On the SCL-90-R scales, parents of children with ODD reported higher scores than the other parents on the global severity index of mental distress  see .r = −0.35, t(123), p < 0.000].Overall, parental GSI in SCL-90-R was positively associated with children's problems as referred by parents on the CBCL [GSI in SCL-90-R and Total score on CBCL: Regarding parental perception of the offspring's psychopathology, on the CBCL total scale, children with ODD received higher scores than TD children. Interestingly, most of the parents of children with ODD reported children's emotional and behavioral problems on the internalizing (74%) and externalizing (64%) scales, respectively.F = 6.9, p = 0.001, F = 5, p = 0.010, F = 3, p = 0.050; On the other hand, parents of children with GAD reported a higher number of emotional problems in their children compared to the control group [Total Scale: F = 10, p = 0.001; F = 7.6, p = 0.000; F = 4, p = 0.000; F = 2, p = 0.090; F = 0.9, p = 0.300; On the CBCL 1½−5 subscales, parents of children with GAD and ODD reported higher scores than TD groups on the Anxiety Problems scale [While mild and transient manifestations of anxiety and oppositionality are considered indices of child adjustment to stressful life events and individual maturation, a persistent, inappropriate, and pervasive expression of such behaviors are regarded as markers of specific disorders. Thus, early recognition by parents of their child's disorders is fundamental for a prompt and suitable therapeutic intervention. However, parental stress might alter their perception of their offspring's problems . To our We found that on the SCL-90 R, parents of children with GAD and ODD scored higher on the anxiety and hostility scales compared to parents of children with TD. Presumably, anxiety and hostility mirror parental fears and feelings of powerlessness associated with children's problems and daily negative environmental feedback. On the other hand, parental anxiety and hostility may, in turn, contribute to an increase in children's vulnerability against psychiatric disorders.Moreover, parental psychological characteristics are differentially related to types of disorder in offspring. Specifically, parents of children with ODD rated high in most of the subscales, which is suggestive of a tendency to not only overestimate a child's disorder, but also the personal problems. Notably, mothers of children with ODD rated high scores on the somatization, depression, anxiety, and paranoid ideation dimensions.Additionally, high scores on somatization, paranoid, hostility, depression, and anxiety dimensions are associated with an impairment of parental ability to empathize with others' emotions and needs. These manifestations are often associated with a low tuning toward others' perspectives and, presumably, with the offspring's developmental needs and difficulties. This finding is interesting in light of social learning theories, which consider that ODD symptoms are the results of negative reinforcement . If the Moreover, it seems relevant to note that mothers of children with psychiatric diagnoses rated higher scores than fathers on several dimensions, namely on somatization, depression, anxiety, hostility, and paranoid ideation. These emotional characteristics may interfere with the mother–child relationship and may contribute to the early development of child psychopathology.Presumably, parents of children with ODD have more problems than parents of children with GAD in elaborating a representation of their own and their children's difficulties.We found the occurrence of psychiatric disorders on clinical diagnosis was comparable frequently in parents of children with ODD or GAD. Personal psychopathological disorders might have influenced parental perceptions of offspring's emotional and behavioral problems. This explanation fits with the finding on the positive association between the personal global index of stress on the SCL-90-R scale and total children's difficulties on the CBCL scale.Most of the parents of children with ODD had a representation of their children that was discordant with the clinical diagnosis. Parents of children with ODD overestimated their child's psychopathological difficulties. According to their parents, children with an ODD would not only show the oppositional behaviors, but also behaviors commonly observed in children with emotional disorders.Parents of children with GAD reported almost exclusively children's emotional difficulties, as was evident on the Internalizing Scale. This result suggested that parents of children with GAD are in tune with their children's actual difficulties.Presumably, parents of children with ODD have more problems than parents of children with GAD in creating an accurate representation of their own and children's difficulties.The social impact of the children with ODD could have influenced the parent's overestimation.It is worth noting that, since the present study was based on correlation analyses, the present findings are not conclusive on any causative relations between variables. Despite this limitation, this study represents one of the few available studies focused on a large sample of preschool children and their families with non-comorbid diagnoses.Further studies are needed to clarify the interplay between parental coping with life changes and the early emergence of psychiatric disorders in preschool children.As interpersonal functioning is impaired differently in generalized anxiety and separation anxiety disorders , future Overall, the present findings have important implications for clinical practice and the elaboration of research and prevention programs. As the evidence indicates, the understanding of the child's problems and functioning should take into account the daily parental perception of their personal and their offspring's psychological conditions.The main limitation of the present study is the lack of input on the part of teachers or daycare operators regarding the child's symptoms.The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.The study was carried out in accordance with the Declaration of Helsinki and approved by the institutional review board of Sapienza–University of Rome. All parents gave a written informed consent to participate in this study.FM, FG, and CS contributed to the study design, supervised and managed data collection, performed statistical analyses, were involved in the data interpretation and the conceptualization of the paper, wrote the first draft of the manuscript, critically revised the manuscript, and approved the final version of the manuscript submitted.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Herbal tea is widely consumed in Jianghua, a Yao autonomous county in Hunan Province, China, to prevent and treat diseases. The materials in herbal tea at the traditional medicinal markets at the Dragon Boat Festival remain unknown. The aims of the paper were (1) to specifically investigate the materials of herbal tea used by Yao nationalities in Hunan Province, (2) to record the most common and the culturally important medicinal plant species in the markets, and (3) to compare the medical plant tradition both used for herbal tea between the Jianghua and Lingnan regions.During 2016–2017, 215 vendors were interviewed at traditional medicinal markets at the Dragon Boat Festival in Jianghua to record plants used for herbal tea and to document traditional knowledge of their medicinal function, habitat, and conservation status. Bunches of medicinal plants were purchased to identify the species and to prepare voucher specimens. Cognitive salience (CS) based on free-lists and use value (UV) were calculated to analyze the cultural importance of medical plants; other quantitative methods  were applied for comparison of herbal tea tradition between the Jianghua and Lingnan regions.A total of 169 species belonging to 66 families and 142 genera were recorded in herbal tea to treat health conditions in the study area. There were 30 health conditions that were recorded, with heat-clearing and detoxifying being the most common medicinal function, followed by treating rheumatism and promoting blood circulation. Of the 169 species, 97 were herbs. The whole plant was the most commonly used plant part in the preparation of herbal tea. According to the national evaluation criteria, three of these species are listed on “China’s red list” and registered as vulnerable (VU). By comparing the coefficient of similarity of herbal tea plants and the number of mentions for part(s) used in Jianghua and Lingnan, the medicinal plant tradition is different in two areas.Herbal tea in Jianghua reflects the cultural diversity of the Yao people and the plant diversity of the region. Future research on the safety, efficacy, and the adulterants of herbal tea are needed for sustainable utilization. Camellia sinensis (L.) O. Ktze. [The practice of drinking herbal tea is an ancient custom for Yao people. Herbal tea is produced from water infusions of a range of plant species other than O. Ktze. . Plant mO. Ktze. . HoweverThe Yao nationality of China is mainly distributed in Guangxi, Hunan, Guangdong, Yunnan, Guizhou, and Jiangxi Provinces. The Yao people from Hunan Province are the birthplace of the Yao nationality; Jianghua Yao Autonomous County has the largest Yao population in Hunan Province, accounting for 53% of the population there . Thus, JThe traditional medical market is a unique custom to celebrate the Dragon Boat Festival  by Yao, Zhuang, and Han people in Jianghua (mostly Yao people). At every Dragon Boat Festival, people collect herbs from surrounding mountains and valleys and sell them at the medical market, which is a large-scale market, with more variety and larger trades. The traditional medical market has become a unique spectacle of Yao medicinal culture customs. In addition to buying and selling various herbs, people take this opportunity to exchange their experiences in the recognition and usage of herbs. Since the Dragon Boat Festival is at the end of spring and the beginning of summer, weather conditions are volatile and moist, which probably contribute to the disease rate. During this time, many Chinese herbal medicines are in the periods of harvesting or barking, so the timing forms the unique medicinal market of Yao nationality in Jianghua.The traditional knowledge of herbs is the result of the accumulated experience by the Yao people’s long-term struggle against disease; thus, many aspects of these treatments are probably scientific. However, like the loss of biodiversity, due to the influence of foreign culture, and not having their own written languages, with descendants inheriting their knowledge just by dictation, the traditional knowledge and culture of Yao medicine is also in danger of being lost. In fact, the vanishing of traditional knowledge has been a common phenomenon in the undeveloped country .In order to protect the traditional knowledge of Yao medicine, guarantee food safety, and meet the increasingly globalized health supplement market, we started to document, explore, and research the herb materials for the preparation of herbal tea in Jianghua in 2016.The study aims to not only document plant species used and commercialized as herbal tea in Jianghua but also make a comparison of herbal tea tradition between the Jianghua and Lingnan regions. This is the first study to document the plant species used as herbal tea in Jianghua; the medicinal plant tradition was recorded for future investigations and policy-making. As well as, if these plant materials are classified and used correctly, the opportunity to develop Yao medicine and expand the herbal tea culture will emerge.2. The total population of Jianghua was 510,000 inhabitants in 2013. It is the only Yao autonomous county in Hunan Province, with the largest population of Yao nationality in the 13 Yao autonomous counties throughout the country. This area features a subtropical monsoon climate, and the weather is relatively moderate, with an annual average temperature of 18–18.5 °C, and plenty of rainfall. It owns the biggest and most famous medicinal market in Hunan Province and the surrounding region, that is, the traditional medicinal markets at the Dragon Boat Festival.The study was conducted in Jianghua, where herbal tea has a significant cultural value and it is traditionally consumed. This region is located in Yongzhou City, which borders Guangdong and Guangxi Provinces, between 110° 25′ S–112° 10′ S and 24° 38′ W–25° 15′ W  Where do you gather this plant? (3) What plant parts can be used for herbal tea? (4) What is the function of this plant in herbal tea? and (5) What plants do Yao people here use for herbal tea? Bunches of medicinal plants were purchased to identify the species and to prepare the voucher specimens followed by the Flora of China (http://frps.eflora.cn/) and the collections in PE , and KUN . We then deposited them in the Ethnobotanical Lab, Minzu University of China. Photographs were taken to record all of the plant species.Field surveys including informant interview, structured investigation, free-listing tasks, and voucher specimen collection were conducted during the Dragon Boat Festival in 2016 and 2017. A total of 215 vendors between 22 and 83 years of age were interviewed at the traditional medicinal markets at the Dragon Boat Festival in Jianghua, Hunan Province, to record plants used for herbal tea and to document traditional knowledge on their medicinal function, habitat, and conservation status. Of the vendors, 70% were over 50 years of age, and these vendors were almost equally male and female. The study was carried out following the International Society of Ethnobiology Code of Ethics [http://rep.iplant.cn/protlist/7) (Table The conservation status of each plant was revised by the Information System of Chinese Rare and Endangered Plants (7) Table .Table 1MCognitive salience (CS)  and use Free-listing is a method to obtain cognitive salience from relatively large samples , 11. IntF is the number of lists where the particular species is mentioned in all lists while Z is the number of informants. B determines how one plant precedes other plants mentioned in a respondent’s list. K is the number of listed species in one informant, and r (i) is the ith order of each plant’s list position.The closer to the first position (or rank) the item(s) are, the greater the cognitive salience of item(s) is deemed to be.The use value (UV) is to quantitatively evaluate the relative importance of species –15 used Ui refers to the number of medical use cited by an informant for per species and N is the total number of all informants. When there are many use reports mentioned for one plant, it indicates the use value of this plant is high.where S) of herbal tea plants between Jianghua and Lingnan regions was calculated by the following formula: S = 2c/(a + b)  [The coefficient of similarity (mon use) .Chi-square analysis was applied to find whether the traditional knowledge of herbal tea such as plant life form and plant part(s) used varied considerably between Jianghua and Lingnan.According to the results of the taxonomical identification, the medicinal plants used for herbal tea belong to 169 species, grouped into 142 genera and 66 families. In alphabetical order of the family, they are presented in Table In this study, the analysis revealed that there were 16 kinds of plant parts that were used for herbal tea as medicinal materials. The whole plant was the most commonly used plant part 38.4%), followed by root (14.2%), leaf (9.13%), stem (7.76%), rhizome (7.76%), and tuber (5.02%) , three of these species are listed on “China’s red list” and registered as vulnerable (VU), which means that they are at the highest risk for endangerment, namely, Dysosma versipellis, Bulbophyllum pectinatum, and Dendrobium nobile. In addition, five species are categorized under least concern (LC), which is a lower category of risk; they are Bulbophyllum odoratissimum, Galeola lindleyana, Luisia morsei, Spiranthes sinensis, and Fagopyrum dibotrys, and 159 species were not evaluated (NE) while Paris polyphylla is listed as second degree national protective plants and Dendrobium officinale is listed as first degree national protective plants. There is a need to investigate and provide proper management to avoid a shortage.According to the evaluation criteria established by the International Union for Conservation of Nature  Solms-Laub., Grangea maderaspatana (L.) Poir., Lophatherum gracile Brongn., Usnea diffracta (Vain.) Articus, Melastoma dodecandrum Lour., Damnacanthus indicus Gaertn., Plantago asiatica L., and Leonurus artemisia (Laur.) S. Y. Hu. The most 20 salient species are listed in Table Artemisia argyi Levl. et Van., which is a fundamental medicinal plant to local people. The least value of cognitive salience is Clematis uncinata Champ.The cognitive salience of 169 species ranked from 0.012 to 0.343 (Table Artemisia princeps (1.74), Viscum liquidambaricola (1.68), Viscum diospyrosicola (1.60), Hedyotis auricularia (1.60), Clerodendrum chinense var. simplex (1.57), Cirsium japonicum (1.54), Achyranthes aspera L. (1.52), Schefflera octophylla (Linn.) Frodin (1.51), Panax japonicus (T. Nees) C. A. Mey. (1.48), and Pseudodrynaria coronans (1.47), which are widely and frequently used by local people.The use value of 169 species ranked from 0.33 to 1.74. They are A comparison of plant materials commonly used for herbal tea in Jianghua and Lingnan shows that there are 23 plant species in total used for herbal tea .The coefficient of similarity of herbal tea plants commonly used in Jianghua and Lingnan is 11.2%. Using chi-square analysis, the number of mentions for part(s) used varied significantly between the two culturally distinct communities (http://www.drugfuture.com/standard/), including Chinese PharmacopeiaI (2015 and 1977 versions), Tibetan medicineI, Uygur medicine, and Japanese Pharmacopoeia, and 124 species are not listed in Pharmacopeia ; many recipes used in herbal tea are evolved from prescriptions of TCM . Howeveriception . CirsiumIn Jianghua, heat-clearing and detoxifying is the most common medicinal function, followed by treating rheumatism, because the Dragon Boat Festival is at the end of spring and the beginning of summer, weather conditions are hot and humid, so the main plant materials used for herbal tea are focused on heat-clearing and detoxifying and treating rheumatism.In Jianghua, 22 species were involved in eliminating inflammation; however, of the 83 species used for heat-clearing and detoxifying, 14 species were involved in eliminating inflammation; it shows that 63.6% of the medicinal plant species sold to eliminate inflammation are also used for heat-clearing and detoxifying, so it is important to conduct some studies to understand the dual effect and discover the possible relationship, which is useful for the theoretical construction of the traditional Chinese medicine (TCM).http://www.nhfpc.gov.cn/). They are Dysosma versipellis (Hance) M. Cheng ex Ying and Tripterygium wilfordii Hook. f.Over the past 20 years, the safety –24 of heDysosma versipellis: Podophyllotoxin, a chemical compound isolated from D. versipellis, is recorded to show cytotoxicity resulting emesis, diarrhea, and hepatic and central nerve system lesion [D. versipellis is largely be utilized for clearing heat and detoxification, rheumatism, and promoting blood circulation by Yao people in Jianghua. However, due to excessive consumption, the conservation status of D. versipellis on “China’s red list” is registered as vulnerable. At present, D. versipellis is cultivated in Jianghua.m lesion –38. Howem lesion . Besidesm lesion . D. versTripterygium wilfordii: The extract of T. wilfordii, a Chinese herb, has anti-inflammatory and immunosuppressive activities and an established history of use in the treatment of rheumatoid arthritis [T. wilfordii are gastrointestinal tract disturbances, such as diarrhea, leukopenia, thrombocytopenia, rash, skin pigmentation, and malfunction of the male and female reproductive system [rthritis , 42. Howe system .The resurgence of interest in natural products has fueled the global herbal tea market. In 2013, Yujing Liu recorded 241 species used for herbal tea in Lingnan Region (China) [Achyranthes aspera, Fagopyrum dibotrys, Lonicera confuse, Lonicera japonica, Dendranthema morifolium, and Juncus effusus are heat-clearing and detoxifying herbs. In Chinese medicine, the lower the fire is equal to clear heat. We found that there may be a relationship between detoxifying and antibacterial or anti-inflammation properties, because most of the plants with detoxifying properties have antibacterial or anti-inflammation effects  show the used plant parts varied significantly between these two different regions. Hence, the variation of used plant part in two regions accounts not only for the particular mentioned used parts but for varied usage rate of each common used part. For example, in Lingnan region, root (20.78%) is the most frequently mentioned used part, while in Lingnan region, it is whole plant (38.36%). The variation of plant part used suggests that the medical plant tradition is far different between the Lingnan and Jianghua regions. The low coefficient of similarity and the variation of plant part used reflect a relatively great difference of herbal tea plant tradition between Jianghua and Lingnan.By comparing the herbal tea plants commonly used by Jianghua and Lingnan, the coefficient of similarity of herbal tea plants is 11.2%, which is low. We compared all plant parts used in the Jianghua and Lingnan regions. The common used plant parts are whole plant, root, leaf, stem, rhizome, tuber, flower, fruit, bark, seed, pith, branch, and shoot thorn. In Lingnan region, there are several particular used plant parts. They were aerial part, bulb, kernel, bud, peel, stigma, stem node with horns, and pollen. However, in Jianghua region, the particular used parts are pod, shoot, and fruit cluster. We selected all common used parts to do statistical analysis with chi-square analysis; the results (Pothos chinensis (Raf.) Merr., Typhonium flagelliforme (Lodd.) Blume, Trachelospermum jasminoides (Lindl.) Lem., Asarum sagittarioides C. F. Liang, Dysosma versipellis (Hance) M. Cheng ex Ying, Celastrus orbiculatus Thunb., Tripterygium wilfordii Hook. f., Senecio scandens Buch.-Ham. ex D. Don, Hemsleya macrosperma C. Y. Wu ex C. Y. Wu et C. L. Chen, Reineckia carnea (Andr.) Kunth, Eomecon chionantha Hance, Fallopia multiflora (Thunb.) Harald., Stemona tuberosa Lour., and Schizocapsa plantaginea Hance. In addition, we do not know if there is a phenomenon of substitutes or adulterants in Jianghua traditional market. Based on the Drug Standard Database, we listed the originality of all of the species (Table In the ethnobotanical surveys, we found that there are 14 poisonous species, which need to be payed attention. They are The traditional medical market in Jianghua Yao Autonomous County reflects the plant species richness and cultural diversity. Traditional knowledge of herbal tea is the result of the accumulated experience by the Yao people’s long-term struggle against disease, so many aspects must be scientific. With the rise of natural product drugs, there is the need to analyze the chemical composition and activity of the materials of herbal tea. Future research is also needed to understand the safety and efficacy of the recorded herbal tea. For sustainable utilization, the production of herbal tea should be monitored.In addition, uniform standards of practice and licensing of herbal vendors is required to produce a safer herbal tea market. It is very important for them to have the knowledge to select the proper plants since some herbs are hard to identify due to similar morphological characteristics.